Self-Management in Chronic Kidney Disease

项目摘要 慢性肾脏病（CKD）在美国是一种日益严重的流行病，随着年龄的增长， 人口老龄化。CKD通常是进行性和不可逆的，并发症包括 心血管疾病和进展为终末期肾病。因此，迫切需要 减少CKD的并发症。 不幸的是，管理CKD受到缺乏疾病特异性治疗的限制，我们必须依靠 广泛的间接策略，以降低CKD不良结局的风险。这些策略严重依赖CKD 患者积极参与促进健康和控制疾病的行为改变（例如，坚持 血压药物，参与健康行为等），统称为自我- 管理行为。迄今为止，对透析前CKD患者自我管理的研究有限， 尽管早期CKD可以说是限制疾病进展和预防并发症的最关键时间。 本研究的总体目的是在慢性肾功能不全队列（CRIC）研究中， 透析前CKD队列，包括：1）描述参与CKD自我管理行为的总体情况， 关键特征，2）探索具有特定慢性肾病自我管理模式的个体亚组 参与，3）评估参与CKD自我管理行为的潜在预测因素，以及4） 调查慢性肾病自我管理参与与长期和短期临床结果的相关性。 通过这些初步分析，我们旨在深入了解CKD自我管理参与及其 与透析前CKD队列临床结局的相关性。我们预计这个项目将产生关键的 深入了解与CKD自我管理参与相关的临床因素，将产生新的 假设，以推动未来的研究，在改善CKD自我管理的领域，通过识别 自我管理参与的障碍和结果不佳风险最高的群体。 NRSA奖学金的申请将为Schrauben博士提供强化培训 在临床流行病学，生物统计学，健康行为和健康素养研究，多方面的职业 与具有不同背景的互补导师一起发展，支持她产生高质量的 数据，进行统计分析，解释调查结果，并准备手稿出版。最终，博士。 Schrauben将获得技能，使她能够成为一名成熟的调查员，并成功地竞争K- 一级职业发展奖，以进一步了解自我管理在CKD中的作用，并帮助告知 对高危人群进行有针对性的干预。

PROJECT SUMMARY Chronic kidney disease (CKD) is a growing epidemic in the United States, and continues to increase with the aging population. CKD is generally progressive and irreversible, with complications including cardiovascular disease and progression to end-stage renal disease. Consequently, there is a compelling need to reduce the complications of CKD. Unfortunately, managing CKD is limited by the lack of disease-specific treatments, and we must rely on broad, indirect strategies to reduce the risk of poor CKD outcomes. These strategies rely heavily on CKD patients to actively participate in behavior changes that promote health and manage the disease (e.g., adhere to blood pressure medications, participate in healthy behaviors, etc.), collectively referred to as self- management behaviors. To date, research of self-management among those with pre-dialysis CKD is limited, although early CKD is arguably the most critical time to limit disease progression and prevent complications. The overall objectives of this study, within the Chronic Renal Insufficiency Cohort (CRIC) Study, a large pre-dialysis CKD cohort, include: 1) describing engagement in CKD self-management behaviors overall and by key characteristics, 2) exploring for sub-groups of individuals with specific patterns of CKD self-management engagement, 3) assessing for potential predictors of engaging in CKD self-management behaviors, and 4) investigating the association of CKD self-management engagement with long and short term clinical outcomes. Through these initial analyses, we aim to gain insights into CKD self-management engagement and its association to clinical outcomes in a pre-dialysis CKD cohort. We anticipate this project will yield critical insights into the clinical factors associated with CKD self-management engagement and will generate new hypotheses to drive future research in the area of improving CKD self-management through the identification of barriers to self-management engagement and groups at the highest risk for poor outcomes. The proposed application for the NRSA fellowship award will provide Dr. Schrauben with intensive training in clinical epidemiology, biostatistics, health behavior and health literacy research, multifaceted career development with complementary mentors with diverse backgrounds, support her to generate high-quality data, perform statistical analysis, interpret the findings, and prepare manuscripts for publication. Ultimately, Dr. Schrauben will gain skills that will enable her to mature as an investigator and compete successfully for a K- level career development award to further understand the role of self-management in CKD and help inform targeted interventions in high-risk groups.