Group-based Chronic Kidney Disease Care

慢性肾脏病团体护理

基本信息

批准号：
8709742
负责人：
Michal L Melamed
金额：
$ 37.58万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-01 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8709742
关键词：
Adherence Adolescent Adolescent and Young Adult Adult Affect African American Ambulatory Blood Pressure Monitoring American Angiotensin Receptor Angiotensin-Converting Enzyme Inhibitors Appointment Area Behavior Behavior Therapy Blood Glucose Blood Pressure Cardiovascular Diseases Caring Cessation of life Childhood Chronic Chronic Disease Chronic Kidney Failure Client satisfaction Clinic Clinic Visits Complex Coronary Arteriosclerosis Data Diabetes Mellitus Diet Diet Habits Disease Disease Progression Education Educational Materials Effectiveness End stage renal failure Enrollment Health Health Personnel Health Status Health education Healthcare Systems Hispanics Hour Hypertension Individual Intake Intervention Kidney Diseases Knowledge Lead Measurement Measures Medical Methods Minority Minority Groups Modeling Motivation Nationalities Nephrology Not Hispanic or Latino Outcome Ownership Participant Patient Self-Report Patients Pharmaceutical Preparations Pharmacy facility Physical activity Physicians Population Printing Progressive Disease Provider Quality of life Randomized Randomized Clinical Trials Recruitment Activity Renal Replacement Therapy Renal function Research Risk Sampling Self Care Self Efficacy Socioeconomic Status Sodium Stroke Testing Translating United States Urine Visit aged arm base blood pressure regulation cardiovascular risk factor care delivery clinical practice cohort cost dietary restriction disorder control empowered experience high risk improved kidney disease education medication compliance meetings patient population peer programs public health relevance racial and ethnic satisfaction skills socioeconomics treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Chronic kidney disease affects approximately 26 million individuals in the United States and is a progressive disease, with individuals losing kidney function yearly. Low kidney function and decrements in kidney function are both individually associated with cardiovascular risk and progression to the need for renal replacement therapy. Racial and ethnic minorities suffer a disproportional burden of kidney disease and its complications. One of the only proven therapies to slow the progression of chronic kidney disease is control of blood pressure (BP) which is difficult to achieve. We will enroll 350 patients with chronic kidney disease aged 12 and older from pediatric and adult chronic kidney disease clinics in the Bronx, NY, a sample composed primarily of non-Hispanic blacks and Hispanics. The 300 adult participants with uncontrolled hypertension will participate in a randomized clinical trial with 2 arms: 1) usual care with monthly CKD clinic visits, including distribution of educational materials from the National Kidney Disease Education Program (NKDEP), or 2) distribution of educational materials from the NKDEP and monthly group-based visits with other patients with CKD in the CKD clinic to encourage medication adherence, dietary restrictions and physical activity. We hypothesize that participants randomized to 6 months of group-based care will show improvements in our outcome measurements including: 24-hour ambulatory BP monitoring, self-reported medication adherence, quality of life, patient satisfaction and 24-hour urine sodium levels and 7 day physical activity measured by pedometer at baseline and 6 months. The study is powered to detect a 5 mmHg difference in 24-hour mean systolic blood pressure between the intervention and usual care groups. The 50 adolescents recruited into the study will undergo the same educational and peer and provider support in group-based care as the adults. We will compare their 24-hour ambulatory blood pressures, missed appointments and dietary and physical activity adherence at the end of the 6 months to their baseline. This application brings together experts in kidney disease (Drs. Kaskel, Bauer, and Melamed) and behavioral interventions for chronic diseases (Drs. Bauman, Doyle and Litwin) to make a strong team poised to perform this research in an underserved, high-needs patient population.

描述（由申请人提供）：慢性肾病影响着美国大约 2600 万人，并且是一种进行性疾病，每年都有人丧失肾功能。肾功能低下和肾功能下降均与心血管风险和进展到需要肾脏替代治疗相关。少数种族和族裔承受着不成比例的肾脏疾病及其并发症的负担。唯一经过验证的减缓慢性肾病进展的疗法之一是控制血压（BP），但这种方法很难实现。我们将从纽约州布朗克斯的儿科和成人慢性肾病诊所招募 350 名 12 岁及以上的慢性肾病患者，样本主要由非西班牙裔黑人和西班牙裔组成。 300 名患有未受控制的高血压的成年参与者将参加一项随机临床试验，分为 2 个组：1) 每月进行 CKD 门诊就诊的常规护理，包括分发国家肾脏病教育计划 (NKDEP) 的教育材料，或 2) 分发 NKDEP 的教育材料，并每月对 CKD 诊所的其他 CKD 患者进行小组访视，以鼓励坚持用药、限制饮食和进行身体活动。我们假设，随机接受 6 个月分组护理的参与者将在我们的结果测量方面表现出改善，包括：24 小时动态血压监测、自我报告的药物依从性、生活质量、患者满意度和 24 小时尿钠水平以及 7基线和 6 个月时通过计步器测量的日间体力活动。该研究能够检测到干预组和常规护理组之间 24 小时平均收缩压存在 5 mmHg 的差异。参与该研究的 50 名青少年将接受与成年人相同的教育、同伴和提供者支持的团体护理。我们将在 6 个月结束时将他们的 24 小时动态血压、错过的预约以及饮食和身体活动的依从性与基线进行比较。该应用程序汇集了肾脏疾病专家（Kaskel、Bauer 和 Melamed 博士）和慢性病行为干预专家（Bauman、Doyle 和 Litwin 博士），组建了一支强大的团队，准备在服务不足、需求高的地区开展这项研究患者群体。