The comparative effectiveness of kidney transplantation in advanced CKD

描述（由申请人提供）：摩根E。Grams，医学博士，MHS，是约翰霍普金斯大学肾脏科的助理教授。她寻求指导患者为导向的研究职业发展奖，以获得基本技能和指导的研究经验，作为一个独立的职业生涯在慢性肾脏疾病领域的医生科学家。该研究提案详细说明了一个五年计划，包括临床流行病学博士水平的课程，由Josef Coresh博士，医学博士，博士和Dorry L。Segev，MD，PhD，以及慢性肾脏疾病相关心血管和死亡风险的流行病学研究。研究议程的具体目标是：1）描述晚期慢性肾脏疾病患者的心血管和死亡风险; 2）在肾脏替代治疗开始之前和之后，确定优先列出的移植候选人的死亡和心血管终点的风险因素; 3）估计移植可行移植候选人的最佳天然肾功能水平。近期的职业目标包括通过与研究计划相结合的学术课程掌握先进的元分析技术，因果推理方法和马尔可夫决策过程模型。从长远来看，Dr. Grams的目标是领导独立的研究项目，调查晚期慢性肾脏疾病的最佳治疗和决策。拟议目标的完成将为100万美国透析前4-5期慢性肾病患者提供重要信息。慢性肾脏疾病与极高的心血管发病率和死亡率相关，但这一人群的最佳治疗方法仍不清楚。先发制人的肾移植或开始维持透析之前的移植是一种越来越常见的治疗方法。与透析开始的趋势相似，在慢性肾脏疾病进展的早期进行。更好地了解肾移植的最佳时机可以为管理已故供体肾列表和分配的国家政策提供信息，并改善活体供体透析前移植患者的临床决策。此外，识别与高心血管和死亡风险相关的特征可用于指导晚期慢性肾脏病人群的治疗和未来试验。

DESCRIPTION (provided by applicant): Morgan E. Grams, MD, MHS, is an Assistant Professor in the Division of Nephrology at Johns Hopkins University. She seeks a Mentored Patient-Oriented Research Career Development Award in order to obtain essential skills and mentored research experience for an independent career as a physician scientist in the field of chronic kidney disease. The research proposal details a five-year plan consisting of doctoral-level coursework in Clinical Epidemiology, mentorship by Dr. Josef Coresh, MD, PhD, and Dr. Dorry L. Segev, MD, PhD, and epidemiologic research in the cardiovascular and mortality risks associated with chronic kidney disease. The specific aims of the research agenda are to: 1) Characterize cardiovascular and mortality risk among individuals with advanced chronic kidney disease; 2) Identify risk factors for death and cardiovascular endpoints in preemptively listed transplant candidates before and after the initiation of renal replacement therapy; and 3) Estimate the optimal level of native kidney function at which a viable transplant candidate should be transplanted. Immediate career goals include the mastery of advanced meta-analysis techniques, methods of causal inference, and Markov decision process models through an academic curriculum integrated with the research plan. Long-term, Dr. Grams aims to lead independent research programs investigating optimal treatment and decision-making in advanced chronic kidney disease. Completion of the proposed aims will provide vital information relevant to the one million U.S. patients with pre-dialysis stage 4-5 chronic kidney disease. Chronic kidney disease is associated with exceedingly high rates of cardiovascular morbidity and mortality, but the optimal treatment of this population remains unknown. Preemptive kidney transplantation, or transplantation prior to the initiation of maintenance dialysis, is an increasingly common therapy. Similar to trends in dialysis initiation, it is being performed earlie in the course of chronic kidney disease progression. A better understanding of the optimal timing of kidney transplantation may inform national policies governing deceased donor kidney listing and allocation, and also improve clinical decision-making for pre-dialysis transplant patients with living donors. Furthermore, identification of characteristics associated with high cardiovascular and mortality risk may be used to guide therapy and future trials in the advanced chronic kidney disease population.