Diet and Hypertension Management in Chronic Kidney Disease

慢性肾脏病的饮食和高血压管理

• 批准号: 10471881
• 负责人: Crystal C Tyson
• 金额: $ 16.02万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471881
• 关键词: Address; Adult; Adverse effects; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Award; Behavior Therapy; Behavioral; Biological Markers; Biometry; Black American; Black Populations; Black race; Blood Pressure; Carbohydrates; Cardiovascular Diseases; Caring; Chronic Kidney Failure; Clinical Research; Clinical Trials; Complex; Conduct Clinical Trials; Control Groups; Counseling; Crystallization; DASH diet; Data; Data Collection; Death Rate; Dialysis procedure; Diet; Diet Modification; Dietary Intervention; Dietary Practices; Disease; Disease Outcome; Doctor of Philosophy; Environmental Risk Factor; Faculty; Feasibility Studies; Feedback; Fishes; Focus Groups; Future; Glomerular Filtration Rate; Goals; Health; Hour; Hypertension; International; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Kidney; Kidney Diseases; Kidney Failure; Kidney Transplantation; Lead; Leadership; Life; Mentors; Mentorship; Metabolic; Metabolic Marker; Mind; Minority; Minority Health Research; Outcome; Participant; Pattern; Perception; Phenotype; Phosphorus; Pilot Projects; Population; Potassium; Public Health; Qualitative Research; Randomized; Research; Research Methodology; Resistance; Safety; Serum; Sodium; Specialist; Structure; Testing; Time; Training; Urea; Urine; Work; acceptability and feasibility; behavior change; behavioral clinical trial; black patient; blood pressure control; blood pressure reduction; cardiovascular disorder risk; career; clinically relevant; design; dietary; dietary adherence; dissemination research; evidence base; feasibility testing; feeding; fruits and vegetables; health disparity; hypertension control; hypertensive; improved; intervention effect; minority health; minority health disparity; mortality; multidisciplinary; pilot test; premature; racial disparity; racial diversity; recruit; saturated fat; skills; social culture; standard of care; treatment arm

Project Summary/Abstract: Excess cardiovascular disease (CVD) mortality among Black Americans with chronic kidney disease (CKD) is a significant US public health disparity. Compared to their White counterparts, Blacks with CKD develop kidney disease earlier in life, are 3 times more likely to develop kidney failure necessitating dialysis or kidney transplantation, and are 1.5 times more likely to die prematurely from CVD. Hypertension, which is also more prevalent, more severe, and less often controlled in Blacks with CKD compared to Whites, is a leading cause of CKD and CVD, and a major contributor to the racial disparity in CVD mortality. Therefore, improving hypertension in Blacks with CKD could have a profound positive impact on an important minority health issue. The long-term career goal of Dr. Crystal Tyson, who is a nephrologist and hypertension specialist, is to develop sustainable interventions that improve hypertension and eliminate racial disparities in CVD among adults with CKD. In her formative work, Dr. Tyson conducted a pilot metabolic feeding study which demonstrated that the Dietary Approaches to Stop Hypertension diet (DASH) lowers BP in Black adults with CKD without having adverse effects on metabolic markers of safety. In this application, Dr. Tyson will move her research forward by modifying an existing DASH counseling intervention that was previously demonstrated by her mentors (Svetkey, Lin) to improve DASH adherence and BP in racially diverse, non-CKD populations, to now specifically address cultural and disease-specific considerations of Blacks with CKD. For Aim 1, she will conduct formative qualitative research involving focus group discussions with Black adults with hypertension and CKD to identify barriers and facilitators of DASH adherence. For Aim 2, she will conduct a randomized controlled pilot study to test feasibility, acceptability, and the preliminary effect on DASH adherence and BP of the newly-modified intervention in 50 Black patients with hypertension and CKD. During the award period, Dr. Tyson will train to develop (1) new skills in qualitative research methods, (2) new skills to conduct behavioral and diet interventions in minority and CKD populations, and (3) enhanced skills in health disparities and minority health research methods. Her highly-accomplished, multi-disciplinary mentorship team will be led by Laura Svetkey, MD, MHS, an internationally recognized hypertension and clinical trial expert who has received several institutional awards for her leadership in faculty diversity and mentoring. Dr. Tyson’s team will also include national leaders in CKD-related health disparities (L. Ebony Boulware, MD, MPH), behavioral intervention and dissemination research (Gary Bennett, PhD, MPH), qualitative research methods (Laura Fish, PhD), and biostatistics (Jane Pendergast, PhD). By accomplishing the research aims and training objectives of this career development award, Dr. Tyson will be prepared to successfully transition to research independence and develop broadly implementable interventions that help eliminate racial disparities in CVD among CKD populations.

项目摘要/摘要： 患有慢性肾病 (CKD) 的美国黑人心血管疾病 (CVD) 死亡率过高 与白肩相比，美国公共卫生存在显着差异，患有慢性肾病的黑人患有肾脏疾病。 在生命早期患上疾病，发生肾衰竭而需要透析或肾病的可能性是其他人的 3 倍 移植后，因高血压过早死亡的可能性增加 1.5 倍，这也更高。 与白人相比，患有 CKD 的黑人普遍、更严重且不易控制，是一个主要原因 CKD 和 CVD 的发病率，也是 CVD 死亡率种族差异的主要原因。 患有慢性肾病的黑人的高血压可能对重要的少数族裔健康问题产生深远的积极影响。 肾病专家和高血压专家 Crystal Tyson 博士的长期职业目标是开发 改善高血压并消除成人心血管疾病种族差异的可持续干预措施 在她的形成性工作中，泰森博士进行了一项试点代谢喂养研究，该研究表明 控制高血压的饮食方法 饮食 (DASH) 可降低患有 CKD 的黑人成人的血压，而无需 对安全代谢标志物的不利影响 在本应用中，泰森博士将通过以下方式推进她的研究。 修改导师之前演示过的现有 DASH 咨询干预措施 (Svetkey, Lin) 迄今为止，旨在提高种族多样化、非 CKD 人群的 DASH 依从性和血压 对于目标 1，她将专门解决患有 CKD 的黑人的文化和疾病特定考虑因素。 进行形成性定性研究，包括与患有高血压的黑人成人进行焦点小组讨论 和 CKD 以确定 DASH 依从性的障碍和促进因素 对于目标 2，她将进行一项随机试验。 对照试点研究，测试可行性、可接受性以及对 DASH 依从性和血压的初步影响 在获奖期间，对 50 名患有高血压和 CKD 的黑人患者进行了新修改的干预措施。 泰森将通过培训培养 (1) 定性研究方法的新技能，(2) 进行行为的新技能 以及对少数族裔和慢性肾病人群的饮食干预，以及 (3) 增强解决健康差异和 她的卓有成就的多学科导师团队将由以下人员领导。 Laura Svetkey，医学博士，MHS，国际公认的高血压和临床试验专家，曾获得 泰森博士的团队还将因其在教师多样性和指导方面的领导力而获得多项机构奖项。 包括 CKD 相关健康差异方面的国家领导人（L. Ebony Boulware，医学博士、公共卫生硕士）、行为学 干预和传播研究（Gary Bennett，博士，公共卫生硕士），定性研究方法（Laura Fish， 博士）和生物统计学（Jane Pendergast，博士）通过完成研究目的和培训目标。 通过这项职业发展奖，泰森博士将为成功过渡到独立研究做好准备 制定广泛可实施的干预措施，帮助消除 CKD 人群中 CVD 的种族差异 人口。