Self-Management in Chronic Kidney Disease

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PROJECT SUMMARY Chronic kidney disease (CKD) is a growing epidemic in the United States, and continues to increase with the aging population. CKD is generally progressive and irreversible, with complications including cardiovascular disease and progression to end-stage renal disease. Consequently, there is a compelling need to reduce the complications of CKD. Unfortunately, managing CKD is limited by the lack of disease-specific treatments, and we must rely on broad, indirect strategies to reduce the risk of poor CKD outcomes. These strategies rely heavily on CKD patients to actively participate in behavior changes that promote health and manage the disease (e.g., adhere to blood pressure medications, participate in healthy behaviors, etc.), collectively referred to as self- management behaviors. To date, research of self-management among those with pre-dialysis CKD is limited, although early CKD is arguably the most critical time to limit disease progression and prevent complications. The overall objectives of this study, within the Chronic Renal Insufficiency Cohort (CRIC) Study, a large pre-dialysis CKD cohort, include: 1) describing engagement in CKD self-management behaviors overall and by key characteristics, 2) exploring for sub-groups of individuals with specific patterns of CKD self-management engagement, 3) assessing for potential predictors of engaging in CKD self-management behaviors, and 4) investigating the association of CKD self-management engagement with long and short term clinical outcomes. Through these initial analyses, we aim to gain insights into CKD self-management engagement and its association to clinical outcomes in a pre-dialysis CKD cohort. We anticipate this project will yield critical insights into the clinical factors associated with CKD self-management engagement and will generate new hypotheses to drive future research in the area of improving CKD self-management through the identification of barriers to self-management engagement and groups at the highest risk for poor outcomes. The proposed application for the NRSA fellowship award will provide Dr. Schrauben with intensive training in clinical epidemiology, biostatistics, health behavior and health literacy research, multifaceted career development with complementary mentors with diverse backgrounds, support her to generate high-quality data, perform statistical analysis, interpret the findings, and prepare manuscripts for publication. Ultimately, Dr. Schrauben will gain skills that will enable her to mature as an investigator and compete successfully for a K- level career development award to further understand the role of self-management in CKD and help inform targeted interventions in high-risk groups.