Diet and Hypertension Management in Chronic Kidney Disease

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Project Summary/Abstract: Excess cardiovascular disease (CVD) mortality among Black Americans with chronic kidney disease (CKD) is a significant US public health disparity. Compared to their White counterparts, Blacks with CKD develop kidney disease earlier in life, are 3 times more likely to develop kidney failure necessitating dialysis or kidney transplantation, and are 1.5 times more likely to die prematurely from CVD. Hypertension, which is also more prevalent, more severe, and less often controlled in Blacks with CKD compared to Whites, is a leading cause of CKD and CVD, and a major contributor to the racial disparity in CVD mortality. Therefore, improving hypertension in Blacks with CKD could have a profound positive impact on an important minority health issue. The long-term career goal of Dr. Crystal Tyson, who is a nephrologist and hypertension specialist, is to develop sustainable interventions that improve hypertension and eliminate racial disparities in CVD among adults with CKD. In her formative work, Dr. Tyson conducted a pilot metabolic feeding study which demonstrated that the Dietary Approaches to Stop Hypertension diet (DASH) lowers BP in Black adults with CKD without having adverse effects on metabolic markers of safety. In this application, Dr. Tyson will move her research forward by modifying an existing DASH counseling intervention that was previously demonstrated by her mentors (Svetkey, Lin) to improve DASH adherence and BP in racially diverse, non-CKD populations, to now specifically address cultural and disease-specific considerations of Blacks with CKD. For Aim 1, she will conduct formative qualitative research involving focus group discussions with Black adults with hypertension and CKD to identify barriers and facilitators of DASH adherence. For Aim 2, she will conduct a randomized controlled pilot study to test feasibility, acceptability, and the preliminary effect on DASH adherence and BP of the newly-modified intervention in 50 Black patients with hypertension and CKD. During the award period, Dr. Tyson will train to develop (1) new skills in qualitative research methods, (2) new skills to conduct behavioral and diet interventions in minority and CKD populations, and (3) enhanced skills in health disparities and minority health research methods. Her highly-accomplished, multi-disciplinary mentorship team will be led by Laura Svetkey, MD, MHS, an internationally recognized hypertension and clinical trial expert who has received several institutional awards for her leadership in faculty diversity and mentoring. Dr. Tyson’s team will also include national leaders in CKD-related health disparities (L. Ebony Boulware, MD, MPH), behavioral intervention and dissemination research (Gary Bennett, PhD, MPH), qualitative research methods (Laura Fish, PhD), and biostatistics (Jane Pendergast, PhD). By accomplishing the research aims and training objectives of this career development award, Dr. Tyson will be prepared to successfully transition to research independence and develop broadly implementable interventions that help eliminate racial disparities in CVD among CKD populations.