Blood Pressure in Advanced Chronic Kidney Disease

描述(申请人提供)：这是为加州大学旧金山分校的肾病学家Nisha Bansal博士申请K23奖项。班萨尔博士在慢性肾脏疾病的心血管疾病和高血压的临床研究中确立了自己年轻研究员的地位。这项K23奖项将为Bansal博士提供必要的支持，以实现以下目标：(1)调查慢性肾脏疾病和终末期肾脏疾病过渡期间患者血压的影响；(2)在临床研究中实施先进的生物统计学方法；(3)与大型多中心队列研究合作；以及(4)发展独立的临床研究事业。为了实现这些目标，Bansal博士组建了一个指导团队，成员包括一位首席导师、加州大学旧金山分校肾脏病学部主任许志远博士，他负责慢性肾脏疾病的流行病学及并发症临床研究；三名共同导师及一名科学顾问：心血管疾病医疗服务研究及慢性肾脏疾病临床流行病学专家Alan Go博士；加州大学旧金山分校成人超声心动图实验室主任Elyse Foster博士；擅长使用统计方法进行纵向数据分析的Charles McCulloch博士；及在高血压和慢性肾脏疾病脉搏波分析方面具有专长的Raymond Townend博士。 心血管疾病是慢性肾脏疾病死亡的主要原因。班萨尔博士的研究将研究在慢性肾脏疾病和终末期肾脏疾病过渡期间血压对心血管疾病和死亡率的影响(目标1)；在这一过渡期(目标2)中央动脉压与结果之间的关系；在慢性肾脏疾病和终末期肾病过渡期间(目标3)醛固酮、血压和结果之间的关系；以及抗高血压药物的使用对这一过渡期结果的影响(目标4)。为了实现这些目标，班萨尔博士将利用一组独特的慢性肾脏疾病患者，作为NIDDK资助的慢性肾功能不全队列(CRIC)的一部分，CRIC是一项由7个临床中心组成的全国性研究。她将利用先进的多元统计分析来实现这些目标。这项研究将形成一项队列研究的基础，以调查血压对心力衰竭和晚期慢性肾脏疾病患者的影响，该研究将在K奖结束前提出的R01拨款申请中提出。 公共卫生相关性：更好地了解血压、血压测量和高血压决定因素对晚期肾病患者的影响，对于改善这类高危患者的长期心血管并发症和生存率至关重要。

DESCRIPTION (provided by applicant): This is an application for a K23 award for Dr. Nisha Bansal, a nephrologist at the University of California, San Francisco. Dr. Bansal is establishing herself as a young investigator in clinical research of cardiovascular disease and hypertension in chronic kidney disease. This K23 award will provide Dr. Bansal with the support necessary to accomplish the following goals: (1) to investigate the impact of blood pressure in patients during the transition between chronic kidney disease and end-stage renal disease; (2) to implement advanced biostatistical methods in clinical studies; (3) to work with a large multi-center cohort study; and (4) to develop an independent clinical research career. To achieve these goals, Dr. Bansal has assembled a mentoring team comprised of a primary mentor, Dr. Chi-yuan Hsu, Division Chief in Nephrology at UCSF, who conducts clinical research on the epidemiology and complications of chronic kidney disease, and three co-mentors and one scientific advisor: Dr. Alan Go, an expert on cardiovascular disease health services research and clinical epidemiology in chronic kidney disease; Dr. Elyse Foster, Director of the UCSF Adult Echocardiography Laboratory; Dr. Charles McCulloch, an authority in the use of statistical methods for longitudinal data analysis; and Dr. Raymond Townsend, who has expertise in hypertension and pulse wave analysis in chronic kidney disease. Cardiovascular disease is the leading cause of mortality in chronic kidney disease. Dr. Bansal's research will study the impact of blood pressure on cardiovascular disease and mortality during the transition between chronic kidney disease and end-stage renal disease (Aim 1); the association between central aortic pressures and outcomes during this transition period (Aim 2); the association between aldosterone, blood pressure and outcomes during the transition between chronic kidney disease and end-stage renal disease (Aim 3); and the impact of the use of anti-hypertension medications on outcomes during this transition period (Aim 4). To achieve these aims, Dr. Bansal will utilize a unique group of patients with chronic kidney disease assembled as part of the NIDDK-funded Chronic Renal Insufficiency Cohort (CRIC), a national study composed of 7 clinical centers. She will utilize advanced multivariate statistical analyses to accomplish these aims. This research will form the basis for a cohort study to investigate the impact of blood pressure in patients with heart failure and advanced chronic kidney disease, to be proposed in an R01 grant application before the end of the K award. PUBLIC HEALTH RELEVANCE: Improved understanding of the impact of blood pressure, measurement of blood pressure, and determinants of blood pressure in patients with advanced stages of kidney disease is critical to improve long-term cardiovascular complications and survival in this high-risk group of patients.