Diet and Hypertension Management in Chronic Kidney Disease

项目概要/摘要： 患有慢性肾病（CKD）的美国黑人中心血管疾病（CVD）死亡率过高， 美国公共卫生的巨大差距。与白色人相比，患有CKD的黑人肾脏 在生命早期患病，发生肾衰竭的可能性是需要透析或肾功能衰竭的3倍。 移植，并有1.5倍的可能性过早死于心血管疾病。高血压，这也是更多 与白人相比，在黑人CKD患者中更普遍，更严重，更不常控制，是一个主要原因 慢性肾脏病和心血管疾病的发病率，是心血管疾病死亡率种族差异的主要因素。因此提高 CKD黑人高血压可能对重要的少数民族健康问题产生深远的积极影响。 Crystal Tyson博士是一名肾病学家和高血压专家，他的长期职业目标是开发 可持续的干预措施，改善高血压和消除成年人CVD的种族差异， CKD。在她的形成工作中，泰森博士进行了一项试验性的代谢喂养研究，该研究表明， 阻止高血压饮食的饮食方法（DASH）降低了患有CKD的黑人成年人的血压， 对代谢安全性标志物的不良影响。在这份申请中，泰森博士将通过以下方式推进她的研究： 修改现有的DASH咨询干预，这是以前由她的导师证明 （Svetkey，Lin）在种族多样的非CKD人群中改善DASH依从性和BP， 特别是针对患有CKD的黑人的文化和疾病特异性考虑。目标1： 进行形成性定性研究，包括与患有高血压的黑人成年人进行焦点小组讨论 和CKD，以确定DASH依从性的障碍和促进因素。对于目标2，她将进行随机 对照试验研究，以测试可行性，可接受性，以及对DASH依从性和BP的初步影响， 对50例黑人高血压合并慢性肾脏病患者进行新的改良干预。在奖励期间，博士。 泰森将培训发展（1）定性研究方法的新技能，（2）进行行为研究的新技能。 在少数民族和CKD人群中进行饮食干预，以及（3）提高健康差异的技能， 少数民族健康研究方法。她的高成就，多学科的导师团队将由 Laura Svetkey，医学博士，MHS，国际公认的高血压和临床试验专家，曾接受 她在教师多样性和指导方面的领导地位获得了几个机构奖项。泰森博士的团队还将 包括国家领导人在CKD相关的健康差距（L。Ebony Boulware，MD，MPH），行为 干预和传播研究（加里班尼特，博士，公共卫生硕士），定性研究方法（劳拉菲什， 生物统计学（Jane Pendergast，PhD）。通过实现研究目标和培训目标， 这个职业发展奖，泰森博士将准备成功过渡到研究独立 并制定可广泛实施的干预措施，帮助消除CKD患者心血管疾病的种族差异 人口。

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.