Trajectories of Adherence to Cardiovascular Medications in Patients on Dialysis

透析患者心血管药物的依从轨迹

• 批准号: 9752556
• 负责人: Jenny I Shen
• 金额: $ 19.03万
• 依托单位: LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-16 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9752556
• 关键词: Adherence; Adrenergic beta-Antagonists; Age; American; Angiotensin II Receptor; Angiotensin-Converting Enzyme Inhibitors; Asians; Attitude; Belief; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Chronic; Clinical; Clinical Sciences; Conflict (Psychology); Data; Data Analyses; Development; Dialysis patients; Dialysis procedure; Drops; Economic Factors; Effectiveness; End stage renal failure; Epidemiology; Ethnic Origin; Ethnic group; Event; Exhibits; Health; Health Services Research; Hispanics; Information Systems; Institutes; Intervention; Interview; Kidney; Knowledge; Life; Maintenance; Master' s Degree; Measures; Medicare; Medicine; Mentors; Methods; Minority; Modeling; Myocardial Infarction; Not Hispanic or Latino; Outcome; Patients; Pattern; Pharmaceutical Preparations; Population; Qualitative Research; Race; Research; Research Methodology; Research Personnel; Resources; Risk; Savings; Stroke; Structure; Testing; Time; Training; Translational Research; Variant; Work; adherence rate; adverse outcome; base; copayment; ethnic diversity; ethnic minority population; experience; improved; improved outcome; innovation; medication compliance; mortality; mortality risk; named group; patient oriented; patient population; pill; primary outcome; public health relevance; racial diversity; racial minority; socioeconomics; tool development

 DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to provide Jenny Shen, MD, MS with the protected time and resources to pursue the training needed to become an independent patient-oriented researcher. Dr. Shen is a board- certified nephrologist with a Master's Degree in Epidemiology. Her research focuses on improving outcomes in patients receiving dialysis, particularly those from racial and ethnic minorities. Cardiovascular (CV) disease is the leading cause of death among patients on maintenance dialysis. While CV medications are a mainstay of treatment, the evidence for their effectiveness in this special population is conflicting. We hypothesize that differences in the trajectories of longer-term adherence to CV medications might explain the variation seen in clinical outcomes for dialysis patients prescribed CV drugs. We propose to determine which trajectories of adherence are associated with the best outcomes and to understand why these different trajectories exist. Our study has three specific aims: 1) to identify trajectories and correlates of longer-term adherence to CV medications in patients initiating dialysis; 2) to assess the relationships among different trajectories of longer-term adherence to CV outcomes in patients receiving dialysis, and to test if these relationships are modified by race and ethnicity; and 3) to describe and compare the experiences, knowledge, and beliefs about longer-term medicine-taking over time and across various racial and ethnic groups receiving dialysis. We will use data from the U.S. Renal Data System, including Medicare Part D prescription claims data. Aim 1 will employ an innovative method of group-based trajectory models to classify patients by their pattern of adherence to CV medications in the first year after dialysis initiation. Aim 2 will use multivariable time-to-event analyses to assess the association between the different patterns of adherence and CV events. Aim 3 will involve serial semi-structured interviews conducted over the course of the patient's first year of maintenance dialysis. Results from the proposed work has the potential to decrease the burden of CV disease in the dialysis population by informing the creation of culturally competent interventions aimed at improving longer-term adherence to CV medications in racially and ethnically diverse populations of patients undergoing dialysis. It will also utilize te resources of the UCLA Clinical and Translational Science Institute to provide the mentored training and experience in advanced quantitative methods of longitudinal data analysis, qualitative research methods, and health services research focused on minorities that will enable the applicant to successfully become an independent, patient-oriented researcher.

 描述（由适用提供）：该K23提案的目的是为医学博士，MS提供受保护的时间和资源，以寻求成为独立的面向患者的研究人员所需的培训。 Shen博士是一名获得董事会认证的肾脏科医生，拥有流行病学硕士学位。她的研究重点是改善接受透析的患者的结局，尤其是赛车和少数民族的患者。心血管（CV）疾病是患者维持透析中死亡的主要原因。尽管简历药物是治疗的主要手段，但其在该特殊人群中有效性的证据却是矛盾的。我们假设长期遵守CV药物的轨迹的差异可能解释了开处方CV药物的透析患者临床结果中看到的差异。我们建议确定哪些依从性轨迹与最佳结果相关，并了解为什么存在这些不同的轨迹。我们的研究具有三个具体的目的：1）确定与患者介绍CV药物长期遵守的轨迹和相关性的相关性； 2）评估接受透析的患者的长期遵守的不同轨迹之间的关系，并测试是否 这些关系是通过种族和种族来修改的； 3）描述和比较随着时间的流逝以及在接受透析的各种种族和种族中使用长期医学的经验，知识和相信。我们将使用来自美国肾脏数据系统的数据，包括Medicare D Perfercription索赔数据。 AIM 1将采用一种创新的基于群体轨迹模型的方法，以在透析计划后的第一年通过遵守CV药物的模式对患者进行分类。 AIM 2将使用多变量的活动时间 分析以评估依从性和简历事件的不同模式之间的关联。 AIM 3将涉及在患者维持透析第一年进行的串行半结构化访谈。拟议工作的结果有可能通过告知旨在提高具有长期依从性的具有文化胜任的干预措施来减少透析人群中CV疾病的Burnen。它还将利用UCLA临床和转化科学研究所的资源来提供纵向数据分析，定性研究方法和卫生服务研究的高级定量方法的指导培训和经验，这些研究侧重于少数群体，这些研究将使适用于成功成为独立的患者，面向患者的独立，面向患者的研究人员。

项目成果

Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

• DOI: 10.1093/eurheartj/ehy060
• 发表时间: 2018-06-21
• 期刊: European heart journal
• 影响因子: 39.3
• 作者: Turakhia MP;Blankestijn PJ;Carrero JJ;Clase CM;Deo R;Herzog CA;Kasner SE;Passman RS;Pecoits-Filho R;Reinecke H;Shroff GR;Zareba W;Cheung M;Wheeler DC;Winkelmayer WC;Wanner C;Conference Participants
• 通讯作者: Conference Participants

Multiple reasons for living donor denial: A single-center experience.

活体捐赠者拒绝的多种原因：单中心经验。

• DOI: 10.1111/ctr.13812
• 发表时间: 2020
• 期刊: Clinical transplantation
• 影响因子: 2.1
• 作者: Lum,ErikL;Shen,JennyI;Beaumont,JenniferL;Treat,Eric;Rastogi,Anjay;Waterman,Amy;Gritsch,HansAlbin
• 通讯作者: Gritsch,HansAlbin

Patient-reported outcome measures for life participation in peritoneal dialysis: a systematic review.

患者报告的腹膜透析生活参与结果测量：系统评价。

• DOI: 10.1093/ndt/gfaa244
• 发表时间: 2021
• 期刊: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
• 作者: Manera,KarineE;Ju,Angela;Baumgart,Amanda;Hannan,Elyssa;Qiao,Wenjing;Howell,Martin;Nataatmadja,Melissa;Wilkie,Martin;Loud,Fiona;Schwartz,Daniel;Hurst,Helen;Jassal,SarbjitVanita;Figueiredo,Ana;Mehrotra,Rajnish;Shen,Jenny;Mort
• 通讯作者: Mort

Developing Consensus-Based Priority Outcome Domains for Trials in Kidney Transplantation: A Multinational Delphi Survey With Patients, Caregivers, and Health Professionals.

• DOI: 10.1097/tp.0000000000001776
• 发表时间: 2017-08
• 期刊: Transplantation
• 影响因子: 6.2
• 作者: Sautenet B;Tong A;Manera KE;Chapman JR;Warrens AN;Rosenbloom D;Wong G;Gill J;Budde K;Rostaing L;Marson L;Josephson MA;Reese PP;Pruett TL;Hanson CS;O'Donoghue D;Tam-Tham H;Halimi JM;Shen JI;Kanellis J;Scandling JD;Howard K;Howell M;Cross N;Evangelidis N;Masson P;Oberbauer R;Fung S;Jesudason S;Knight S;Mandayam S;McDonald SP;Chadban S;Rajan T;Craig JC
• 通讯作者: Craig JC

Balancing the Evidence: How to Reconcile the Results of Observational Studies vs. Randomized Clinical Trials in Dialysis.

平衡证据：如何协调透析中观察性研究与随机临床试验的结果。

• DOI: 10.1111/sdi.12518
• 发表时间: 2016
• 期刊: Seminars in dialysis
• 影响因子: 1.6
• 作者: Shen,JennyI;Lum,ErikL;Chang,TaraI
• 通讯作者: Chang,TaraI