Patient-Oriented Research Addressing Disparities in Hypertension and Kidney Disease

以患者为中心的研究解决高血压和肾脏疾病的差异

• 批准号: 10414920
• 负责人: DEIDRA CANDICE CREWS
• 金额: $ 10.74万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-17 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10414920
• 关键词: Address; Adherence; Adoption; Adult; Affect; African American population; Age of Onset; Albumins; Albuminuria; Beverages; Blood Pressure; Cardiovascular Diseases; Chronic Kidney Failure; Clinical; Clinical Research Associate; DASH diet; Diet; Dietary Factors; Dietary Intervention; Dietary Practices; Disease Progression; Eating; End stage renal failure; Excretory function; Face; Faculty; Food; Future; Gifts; Goals; Health Food; Healthy Eating; Housing; Hypertension; Individual; Intervention; Intervention Studies; Interview; Kidney; Kidney Bean; Kidney Diseases; Kidney Failure; Knowledge; Lead; Low income; Medicine; Mentors; Mentorship; Mid-Career Clinical Scientist Award (K24); Midcareer Investigator Award in Patient-Oriented Research; Nephrology; Nutritional; Nuts; Observational Study; Outcome; Participant; Pattern; Persons; Phase; Phase Transition; Postdoctoral Fellow; Prevention Research; Randomized; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Scholarship; Socioeconomic Factors; Structure; Students; Time; Universities; Work; base; career; dietary; disadvantaged population; disorder risk; disparity reduction; epidemiology study; ethnic minority; experience; food desert; food insecurity; fruits and vegetables; good diet; group intervention; health equity; high risk; implementation research; improved outcome; indexing; low socioeconomic status; medical schools; mid-career faculty; patient oriented research; phase 1 study; primary outcome; racial and ethnic; racial difference; racial disparity; randomized trial; renal damage; research and development; secondary outcome; socioeconomic disadvantage; therapy design; treatment arm; treatment as usual; urinary

PROJECT SUMMARY/ABSTRACT This is a proposal for a K24 Midcareer Investigator Award in Patient-Oriented Research for Deidra C. Crews, MD, ScM of Johns Hopkins University School of Medicine. Dr. Crews is an Associate Professor of Medicine in the Division of Nephrology, Core Faculty in the Welch Center for Prevention, Epidemiology and Clinical Research, and Associate Director for Research Development in the Center for Health Equity. Dr. Crews has spent the majority of her career and scholarship focused on patient-oriented research in disadvantaged populations with hypertension and/or chronic kidney disease (CKD). African Americans are disproportionately affected by hypertension and CKD, and socioeconomic factors contribute to these disparities. Racial disparities in CKD are most profound among socioeconomically disadvantaged populations. Low socioeconomic status (SES) and limited availability of healthy foods contribute to poor dietary patterns which influence CKD risk. There is evidence from observational studies that adherence to healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) diet, may substantially reduce risk of CKD and short-term randomized trials suggest the adoption of a healthy diet in adults with CKD may reduce risk of disease progression. The important problem to be addressed by the applicant over the proposed 5-year K24 award period is that low SES African Americans with hypertension and CKD face multiple barriers to healthful eating which can lead to their poor outcomes, including cardiovascular disease and ESRD. This K24 award will protect time for the applicant to mentor junior investigators and conduct significant research aimed at developing sustainable dietary interventions for individuals at high risk for poor clinical outcomes related to hypertension and CKD. The proposed original research will be conducted in the context of the Five, Plus Nuts and Beans for Kidneys trial, a randomized controlled dietary intervention study of low SES African Americans with hypertension and CKD, and will (a) elucidate experiences of recent intervention-arm (Coaching-DASH) participants determining their views on intervention components and factors facilitating or impeding their dietary changes, (b) examine the purchase patterns of the usual care group (Shopping-DASH), who received a trackable gift card to a local grocer but no guidance on purchases and (c) characterize and determine the impact of financial resource strain (defined as housing and/or food insecurity) on the primary and secondary outcomes of the trial—reductions in urinary albumin excretion and blood pressure. These aims will be addressed while Dr. Crews provides mentorship to new and existing junior faculty, post-doctoral fellows and students. Work performed during the K24 award will both inform future intervention design and implementation approaches to maximize sustainability of the applicant’s work, and will allow her to more effectively pursue her long-term career goals to improve outcomes for disadvantaged populations with or at risk for CKD.

项目概要/摘要 这是为 Deidra C. Crews 申请 K24 职业生涯中期研究员以患者为导向的研究奖的提案， 约翰·霍普金斯大学医学院医学博士、理学硕士。克鲁斯博士是医学副教授 韦尔奇预防、流行病学和临床中心核心教员肾脏科 健康公平中心研究和研究开发副主任。克鲁斯博士有 她的职业生涯和学术生涯的大部分时间都集中在弱势群体中以患者为导向的研究上 患有高血压和/或慢性肾病（CKD）的人群。非裔美国人比例失调 受高血压和慢性肾病的影响，以及社会经济因素导致了这些差异。种族差异 慢性肾病的影响在社会经济弱势群体中最为严重。社会经济地位低 (SES) 和健康食品供应有限导致不良饮食模式，从而影响 CKD 风险。 观察性研究的证据表明，坚持健康的饮食模式，例如饮食 控制高血压 (DASH) 饮食的方法可显着降低慢性肾病 (CKD) 和短期疾病的风险 随机试验表明，患有 CKD 的成人采用健康饮食可以降低患病风险 进展。申请人在拟议的5年期K24奖项中需要解决的重要问题 在此期间，社会经济地位低、患有高血压和慢性肾病的非裔美国人面临着健康饮食的多重障碍 这可能导致他们的不良后果，包括心血管疾病和终末期肾病（ESRD）。这个K24奖将 为申请人留出时间指导初级研究人员并进行旨在实现以下目标的重大研究： 为临床结果不佳的高风险个体制定可持续的饮食干预措施 高血压和慢性肾病。拟议的原创研究将在“五加坚果”的背景下进行 和豆类肾脏试验，一项针对低社会经济地位非裔美国人的随机对照饮食干预研究 患有高血压和 CKD，并将 (a) 阐明近期干预组的经验（Coaching-DASH） 参与者确定他们对干预组成部分和促进或阻碍他们的因素的看法 饮食变化，（b）检查常规护理组（Shopping-DASH）的购买模式，他们接受了 向当地杂货店提供可追踪的礼品卡，但没有购买指导；(c) 描述并确定 财政资源紧张（定义为住房和/或粮食不安全）对小学和中学的影响 试验结果——尿白蛋白排泄量和血压降低。这些目标将是 克鲁斯博士为新任和现有的初级教师、博士后研究员和 学生。 K24 奖项期间所做的工作将为未来的干预设计和实施提供信息 最大限度地提高申请人工作的可持续性的方法，并使她能够更有效地追求自己的目标 改善患有慢性肾病或有慢性肾病风险的弱势群体的结果的长期职业目标。