Blood Pressure in Advanced Chronic Kidney Disease

描述（由申请人提供）：这是弗朗西斯科加州大学肾病学家Nisha Bansal博士的K23奖申请。Bansal博士正在确立自己作为慢性肾脏疾病心血管疾病和高血压临床研究的年轻研究者的地位。该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之间的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方法;（3）与大型多中心队列研究合作;（4）研究慢性肾脏疾病和终末期肾脏疾病之间的关系。（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，由一位主要导师，UCSF肾脏科主任Chi-yuan Hsu博士，他对慢性肾脏病的流行病学和并发症进行临床研究，以及三位共同导师和一位科学顾问组成：Alan Go博士，心血管疾病健康服务研究和慢性肾脏病临床流行病学专家; Elyse Foster博士，加州大学旧金山分校成人超声心动图实验室主任; Charles McCulloch博士，纵向数据分析统计方法的权威; Raymond汤森博士，在高血压和慢性肾脏疾病脉搏波分析方面具有专长。 心血管疾病是慢性肾脏疾病死亡的主要原因。Bansal博士的研究将研究在慢性肾脏疾病和终末期肾脏疾病之间的过渡期间血压对心血管疾病和死亡率的影响（目标1）;在此过渡期间中心主动脉压和结果之间的关联（目标2）;醛固酮之间的关联，慢性肾脏疾病和终末期肾脏疾病之间过渡期间的血压和结局（目标3）;以及在此过渡期内使用抗高血压药物对结局的影响（目标4）。为了实现这些目标，Bansal博士将利用一组独特的慢性肾病患者，作为NIDDK资助的慢性肾功能不全队列（CRIC）的一部分，这是一项由7个临床中心组成的国家研究。她将利用先进的多元统计分析来实现这些目标。这项研究将为一项队列研究奠定基础，该研究旨在调查血压对心力衰竭和晚期慢性肾脏病患者的影响，该研究将在K奖结束前在R 01资助申请中提出。 公共卫生相关性：提高对晚期肾病患者血压影响、血压测量和血压决定因素的认识，对于改善这一高危患者群体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.