Towards optimizing care for cardiovascular disease in chronic kidney disease

描述(申请人提供)：这份K23提案的目的是为Tara I.Chang医学博士和硕士提供受保护的时间和资源，使她能够继续进行所需的额外培训，以实现她成为一名独立的以患者为中心的研究人员的长期目标。张博士是一名经过董事会认证的肾病学家和训练有素的流行病学家，她的研究重点是心血管疾病和慢性肾脏疾病(CKD)的交叉。慢性肾脏疾病增加了心血管疾病的发病率和死亡率，而心血管疾病是慢性肾脏病死亡的主要原因。就诊-就诊血压变异性(BPV)是指血压在几天到几个月内发生的变化，正在成为非CKD患者死亡和心血管事件的重要危险因素，与平均或正常血压无关。对于慢性肾脏病患者的来访BPV知之甚少，CKD患者是不良临床事件的高危人群。此外，到目前为止，还没有一个统一的衡量标准来表征访问到访问的BPV。该项目建议对包括终末期肾病(ESRD)在内的CKD患者进行一系列分析，以填补与该人群中来访BPV的决定因素和后果相关的一些证据空白。本项目的具体目标是确定就诊-就诊-就诊BPV的最佳指标；更好地表征传统的、以患者为中心的就诊-就诊BPV的决定因素； 比较降压药物对临床结果的有效性，评估差异是否由就诊到就诊BPV的差异所调节；并评估就诊到就诊BPV作为一种超越收缩压、舒张压或平均动脉压的新的风险标志物的增量预后价值。这项拟议的工作有很高的潜力产生重大的临床影响，因为项目目标的完成不仅将促进目前对慢性肾脏病中来访BPV的理解，而且还将提供关于假定的危险因素的初步数据，以便在未来的干预试验中针对目标，旨在降低来访BPV和改善 临床结果。重要的是，拟议的工作在获奖期内是现实和可行的，并将使张博士能够继续建立研究技能，生成初步数据，创建更多的合作网络，并竞争R01资金。总而言之，K23奖项将支持拟议的培训和职业发展活动，使张博士能够成功地进入她作为独立临床研究员的职业生涯的下一阶段。

DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to provide Tara I. Chang, MD, MS with the protected time and resources to allow her to pursue the additional training needed to reach her long-term goal of becoming an independent patient-oriented investigator. Dr. Chang is a board-certified nephrologist and trained epidemiologist, and her research focuses on the intersection of cardiovascular disease and chronic kidney disease (CKD). Chronic kidney disease confers an increased risk for cardiovascular morbidity and mortality, and cardiovascular disease is the leading cause of death in CKD. Visit-to-visit blood pressure variability (BPV), defined as variation in blood pressure that occurs over days to months, is emerging as an important risk factor for death and cardiovascular events independent of mean or usual blood pressure in patients without CKD. Relatively little is known about visit-to-visit BPV in patients with CKD, a population at high risk for adverse clinical event. In addition, to date there is no uniform metric used to characterize visit-to-visit BPV. This projet proposes a series of analyses in patients with CKD, including end-stage renal disease (ESRD), to close some of the evidence gaps related to determinants and consequences of visit-to-visit BPV in this population. The specific aims of this project are to define the best metrics of visit-t-visit BPV; better characterize traditional and patient-centered determinants of visit-to-visit BPV; compare the effectiveness of antihypertensive medications on clinical outcomes and evaluate whether differences are mediated by differences in visit-to-visit BPV; and evaluate the incremental prognostic value of visit-to-visit BPV as a novel risk marker beyond systolic, diastolic, or mean arterial blood pressure. The proposed work has high potential to make a significant clinical impact, as completion of the project aims will not only advance the current understanding of visit-to-visit BPV in CKD, but also provide preliminary data on putative risk factors to target in a future intervention trial aimed at lowering visit-to-visit BPV and improving clinical outcomes. Importantly, the proposed work is realistic and feasible within the award period, and will allow Dr. Chang to continue to build research skills, generate preliminary data, create additional collaborative networks, and compete for R01 funding. In summary, the K23 award will support the proposed training and career development activities to allow Dr. Chang to launch successfully into the next phase of her career as an independent clinical investigator.