Patient-Oriented Research Addressing Disparities in Hypertension and Kidney Disease

项目概要/摘要 这是Deidra C的K24职业中期研究者奖的提案。船员们， 约翰霍普金斯大学医学院医学博士、理学硕士。克鲁斯博士是一名医学副教授， 韦尔奇预防、流行病学和临床研究中心的肾脏病学分部 研究，并在健康公平中心的研究发展副主任。克鲁斯医生 她的大部分职业生涯和奖学金都集中在以病人为导向的研究中， 患有高血压和/或慢性肾病（CKD）的人群。非洲裔美国人不成比例地 受高血压和CKD影响，社会经济因素导致了这些差异。种族差异 CKD的发病率在社会经济弱势群体中最为严重。社会经济地位低 (SES)健康食品的有限供应导致影响CKD风险的不良饮食模式。 有证据表明，从观察性研究，坚持健康的饮食模式，如饮食 停止高血压的方法（DASH）饮食，可以大大降低CKD的风险， 随机试验表明，CKD成人采用健康饮食可降低疾病风险 进展申请人在拟议的5年K24奖中需要解决的重要问题 低SES的非裔美国人高血压和CKD面临着健康饮食的多重障碍， 这可能导致他们的不良结局，包括心血管疾病和终末期肾病。K24奖项将 保护申请人指导初级研究人员和进行重要研究的时间， 为与以下疾病相关的临床结局不良的高风险个体制定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方面进行，加上坚果 豆类肾脏试验，一项针对低SES非洲裔美国人的随机对照饮食干预研究 高血压和CKD患者，并将（a）阐明近期干预组（指导-DASH）的经验 与会者确定他们对促进或阻碍其发展的干预内容和因素的看法。 饮食改变，（B）检查常规护理组（购物-DASH）的购买模式， 可跟踪的礼品卡给当地杂货店，但没有关于购买的指导，以及（c）表征和确定 财政资源紧张（定义为住房和/或粮食无保障）对小学和中学的影响 试验结果-尿白蛋白排泄和血压降低。这些目标将是 解决，而克鲁斯博士提供指导，以新的和现有的初级教师，博士后研究员， 学生在K24授予期间进行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她的工作。 长期职业目标，以改善患有CKD或有CKD风险的弱势人群的结局。

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.