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.

项目摘要/摘要 这是针对Deidra C. Crews的K24中级护理研究员奖的提案， 约翰·霍普金斯大学医学院的SCM医学博士。 Crews博士是医学副教授 肾脏科，韦尔奇预防，流行病学和临床中心的核心教师 研究，卫生公平中心研究开发副总监。 Crews博士有 将她的职业生涯大部分和奖学金都集中在灾难中的研究 患有高血压和/或慢性肾脏疾病（CKD）的人群。非洲裔美国人的比例不成比例 受高血压和CKD的影响，社会经济因素导致了这些差异。种族差异 在CKD中，在社会经济上处于弱势群体中最为深刻。社会经济地位低 （SES）和健康食品的可用性有限，导致饮食模式不佳，从而影响CKD风险。 观察性研究有证据表明遵守健康的饮食模式，例如饮食 停止高血压（DASH）饮食的方法可能会大大降低CKD的风险和短期 随机试验表明，在患有CKD的成年人中采用健康饮食可能会降低疾病的风险 进展。适用于拟议的5年K24奖的重要问题要解决 时期是低血压和CKD的低SES非洲裔美国人面临多个健康饮食的障碍 这可能导致其不良结果，包括心血管疾病和ESRD。这个K24奖将 保护申请人的精神初级研究人员的时间，并进行针对的大量研究 针对与临床结果不佳的个人相关的临床结果高风险的个体开发可持续的饮食干预措施 高血压和CKD。拟议的原始研究将在五个背景下进行，加上坚果 和用于肾脏试验的豆是一项随机控制的饮食干预研究，对非裔美国人 有高血压和CKD，并将（a）阐明最近的干预臂（教练）体验 参与者确定他们对促进或阻碍其干预组件和因素的看法 饮食变化，（b）检查了通常的护理小组（购物扣）的购买模式，他们接受了 可追踪的礼品卡给当地杂货商，但没有购买指导，（c）表征并确定 金融资源应变（定义为住房和/或粮食不安全）对初级和次要的影响 试验的结果 - 尿白蛋白排泄和血压的还原。这些目标将是 在Crews博士为新的和现有的初级教师，博士后研究员和 学生。在K24奖上进行的工作将为未来的干预设计和实施提供信息 方法以最大化申请人工作的可持续性，并使她能够更有效地追求她 长期的职业目标，以改善有CKD风险或有风险的灾难人群的成果。