Group-based Chronic Kidney Disease Care

描述(申请人提供)：慢性肾脏疾病在美国影响大约2600万人，是一种进行性疾病，每年都会有肾功能丧失。肾功能低下和肾功能减退分别与心血管风险和进展到需要肾脏替代治疗有关。少数族裔承受着肾脏疾病及其并发症的不成比例的负担。控制血压(BP)是唯一被证明可以减缓慢性肾脏疾病进展的疗法之一，但这一点很难实现。我们将从纽约州布朗克斯区的儿童和成人慢性肾脏疾病诊所招募350名12岁及以上的慢性肾脏疾病患者，样本主要由非西班牙裔黑人和西班牙裔组成。300名患有未控制高血压的成年参与者将参加一项随机临床试验，试验分为两组：1)每月CKD门诊常规护理，包括 分发国家肾脏疾病教育计划(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患者进行小组访问，以鼓励遵守药物治疗、饮食限制和体育锻炼。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显示出改善，包括：24小时动态血压监测、自我报告的服药依从性、生活质量、患者满意度以及在基线和6个月时用计步器测量的24小时尿钠水平和7天体力活动。这项研究旨在检测干预组和常规护理组24小时平均收缩压之间的5毫米汞柱差异。被招募到研究中的50名青少年将接受与成年人相同的教育、同伴和提供者支持，以小组为基础的护理。我们将比较他们在6个月结束时的24小时动态血压、错过的约会以及饮食和体力活动的依从性与他们的基线。该应用程序汇集了肾脏疾病(Kaskel、Bauer和Melame博士)和慢性病行为干预(Bauman、Doyle和Litwin博士)方面的专家，组成了一个强大的团队，准备在服务不足、高需求的患者群体中进行这项研究。

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.