Group-based Chronic Kidney Disease Care

描述（由申请人提供）：慢性肾病影响着美国大约 2600 万人，并且是一种进行性疾病，每年都有人丧失肾功能。肾功能低下和肾功能下降均与心血管风险和进展到需要肾脏替代治疗相关。少数种族和族裔承受着不成比例的肾脏疾病及其并发症的负担。唯一经过验证的减缓慢性肾病进展的疗法之一是控制血压（BP），但这种方法很难实现。我们将从纽约州布朗克斯的儿科和成人慢性肾病诊所招募 350 名 12 岁及以上慢性肾病患者，样本主要由非西班牙裔黑人和西班牙裔人组成。 300 名患有未受控制的高血压的成年参与者将参加一项随机临床试验，分为 2 个组：1) 每月 CKD 门诊就诊的常规护理，包括 分发国家肾脏病教育计划 (NKDEP) 的教育材料，或 2) 分发 NKDEP 的教育材料，并每月对 CKD 诊所的其他 CKD 患者进行小组访视，以鼓励坚持用药、限制饮食和进行身体活动。我们假设，随机接受 6 个月分组护理的参与者将在我们的结果测量方面表现出改善，包括：24 小时动态血压监测、自我报告的药物依从性、生活质量、患者满意度和 24 小时尿钠水平以及基线和 6 个月时通过计步器测量的 7 天体力活动。该研究能够检测到干预组和常规护理组之间 24 小时平均收缩压存在 5 mmHg 的差异。参与这项研究的 50 名青少年将接受与成年人相同的教育、同伴和提供者的团体护理支持。我们将在 6 个月结束时将他们的 24 小时动态血压、错过的预约以及饮食和身体活动的依从性与基线进行比较。该应用程序汇集了肾脏疾病专家（Kaskel、Bauer 和 Melamed 博士）和慢性病行为干预专家（Bauman、Doyle 和 Litwin 博士），组成了一支强大的团队，准备在服务不足、高需求的患者群体中开展这项研究。

DESCRIPTION (provided by applicant): Chronic kidney disease affects approximately 26 million individuals in the United States and is a progressive disease, with individuals losing kidney function yearly. Low kidney function and decrements in kidney function are both individually associated with cardiovascular risk and progression to the need for renal replacement therapy. Racial and ethnic minorities suffer a disproportional burden of kidney disease and its complications. One of the only proven therapies to slow the progression of chronic kidney disease is control of blood pressure (BP) which is difficult to achieve. We will enroll 350 patients with chronic kidney disease aged 12 and older from pediatric and adult chronic kidney disease clinics in the Bronx, NY, a sample composed primarily of non-Hispanic blacks and Hispanics. The 300 adult participants with uncontrolled hypertension will participate in a randomized clinical trial with 2 arms: 1) usual care with monthly CKD clinic visits, including distribution of educational materials from the National Kidney Disease Education Program (NKDEP), or 2) distribution of educational materials from the NKDEP and monthly group-based visits with other patients with CKD in the CKD clinic to encourage medication adherence, dietary restrictions and physical activity. We hypothesize that participants randomized to 6 months of group-based care will show improvements in our outcome measurements including: 24-hour ambulatory BP monitoring, self-reported medication adherence, quality of life, patient satisfaction and 24-hour urine sodium levels and 7 day physical activity measured by pedometer at baseline and 6 months. The study is powered to detect a 5 mmHg difference in 24-hour mean systolic blood pressure between the intervention and usual care groups. The 50 adolescents recruited into the study will undergo the same educational and peer and provider support in group-based care as the adults. We will compare their 24-hour ambulatory blood pressures, missed appointments and dietary and physical activity adherence at the end of the 6 months to their baseline. This application brings together experts in kidney disease (Drs. Kaskel, Bauer, and Melamed) and behavioral interventions for chronic diseases (Drs. Bauman, Doyle and Litwin) to make a strong team poised to perform this research in an underserved, high-needs patient population.