Maximizing The Benefit of Therapy in CKD

最大化 CKD 治疗的益处

基本信息

批准号：
10659331
负责人：
Alexander R Chang
金额：
$ 75.5万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10659331
关键词：
Address Adherence Adult Adverse effects Albuminuria Algorithms Ancillary Study Angiotensin Receptor Angiotensin-Converting Enzyme Inhibitors Area Back Benefits and Risks Caring Characteristics Chronic Kidney Failure Clinical Practice Guideline Clinical Trials Data Data Set Data Sources Decision Making Dedications Development Diabetes Mellitus Disease Progression Dose Drug Interactions Drug Prescriptions Electronic Health Record Eligibility Determination Enrollment Evaluation Fire - disasters Glean Glomerular Filtration Rate Glucose Goals Grant Guidelines Health Health system Heart failure Hypertension International Investigation Israel Kidney Knowledge Marketing Measures Medical Metformin Methods Monitor New York Outcome Patient Care Patients Peptidyl-Dipeptidase A Persons Pharmaceutical Preparations Pharmacoepidemiology Phase Prevention strategy Probability Provider Randomized Recommendation Regimen Renal function Research Research Personnel Risk Risk Assessment Sample Size Sodium Spironolactone Structural Models Sweden System Target Populations Testing Therapeutic Time Translating Translations Universities Work active comparator clinical care clinical decision support cohort data de-identification design disease prognosis electronic health system evidence base high risk high risk population implementation science improved individual patient individualized prevention inhibitor inhibitor therapy medication safety novel patient subsets pharmacologic point of care post-market premature response rosuvastatin stem study population support tools symporter targeted treatment tool treatment strategy

项目摘要

ABSTRACT The first phase of this grant aimed to generate evidence to promote appropriate, safe, and effective use of medications across the range of kidney function. We established a dedicated pharmacoepidemiology group and investigated medication use across the spectrum of glomerular filtration rate (GFR) in >5 million patients in 5 international health systems. We evaluated the risks and benefits of many common medications and medication classes: metformin, angiotensin converting enzyme (ACE)-inhibitors, angiotensin receptor blockers (ARBs), spironolactone, and rosuvastatin, among others. We identified large gaps in guideline-recommended monitoring and medical management, such as the pervasive undertesting of albuminuria among patients with diabetes and hypertension. In this renewal application, we expand the prior study population to include additional large health systems covering approximately 25 million patients with measures of kidney function. We incorporate current data to enable investigation of newer classes of medications, such as sodium glucose co-transporter-2 inhibitors (SGLT2-Is). We extend expertise of the investigative team to include leaders in implementation science and clinical decision support, allowing translation of findings back into local electronic health systems. The overall premise of the application is that, by using post-marketing real-world data, we can provide essential evidence to inform optimal care practices for patients with or at risk for chronic kidney disease (CKD). Using SGLT2-Is as the primary example, we propose first to identify gaps in care, quantifying the number of patients not receiving SGLT2-Is who are recommended to do so under clinical practice guidelines. Next, we identify subgroups of patients most likely to benefit from SGLT2-I therapy through a careful assessment of risks and benefits across individual patient characteristics. Finally, we develop and refine clinical decision support tools that identify high-risk patients in real time who are lacking SGLT2-I therapy. In summary, with the overall goal of simplifying provider decision-making and optimizing medical treatment for patients with or at risk for CKD, this renewal application proposes to identify gaps in care, refine target populations for beneficial medical therapies, and translate knowledge to the point of patient care. .

抽象的该赠款的第一阶段旨在产生证据以促进适当、安全和有效的使用涵盖肾功能范围的药物。我们成立了专门的药物流行病学小组并调查了超过 500 万患者的肾小球滤过率 (GFR) 范围内的药物使用情况 5 个国际卫生系统。我们评估了许多常见药物的风险和益处，药物类别：二甲双胍、血管紧张素转换酶 (ACE) 抑制剂、血管紧张素受体阻滞剂（ARB）、螺内酯和瑞舒伐他汀等。我们发现与指南建议存在巨大差距监测和医疗管理，例如患有以下疾病的患者普遍存在蛋白尿检测不足的情况糖尿病和高血压。在此更新应用程序中，我们扩大了先前的研究人群以包括其他大型卫生系统覆盖约 2500 万患者的肾功能测量。我们将当前数据合并到能够研究新型药物，例如钠葡萄糖协同转运蛋白 2 抑制剂（SGLT2-Is）。我们扩展调查团队的专业知识，包括实施科学和技术领域的领导者临床决策支持，允许将研究结果转化回本地电子医疗系统。该应用程序的总体前提是，通过使用上市后的真实数据，我们可以提供为慢性肾病 (CKD) 患者或有患慢性肾病 (CKD) 风险的患者提供最佳护理实践的重要证据。使用 SGLT2-Is 作为主要示例，我们建议首先确定护理方面的差距，量化根据临床实践指南建议未接受 SGLT2-Is 治疗的患者。接下来，我们通过仔细评估，确定最有可能从 SGLT2-I 治疗中受益的患者亚组不同患者特征的风险和益处。最后，我们制定并完善临床决策支持工具实时识别缺乏 SGLT2-I 治疗的高危患者。总而言之，随着简化医疗服务提供者的决策并优化患有或面临风险的患者的医疗治疗的总体目标对于 CKD，此更新申请建议找出护理方面的差距，细化目标人群以实现有益的目标医学治疗，并将知识转化为患者护理。。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The FDA Metformin Label Change and Racial and Sex Disparities in Metformin Prescription among Patients with CKD.

FDA 二甲双胍标签变更以及 CKD 患者二甲双胍处方中的种族和性别差异。

DOI：
10.1681/asn.2019101119
发表时间：
2020
期刊：
Journal of the American Society of Nephrology : JASN
影响因子：
0
作者：
Shin,Jung-Im;Sang,Yingying;Chang,AlexR;Dunning,StephanC;Coresh,Josef;Inker,LesleyA;Selvin,Elizabeth;Ballew,ShoshanaH;Grams,MorganE
通讯作者：
Grams,MorganE

Obesity and Chronic Kidney Disease in US Adults With Type 1 and Type 2 Diabetes Mellitus.

美国 1 型和 2 型糖尿病成人的肥胖和慢性肾脏病。

DOI：
10.1210/clinem/dgab927
发表时间：
2022
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
0
作者：
Wallace,AmeliaS;Chang,AlexR;Shin,Jung-Im;Reider,Jodie;Echouffo-Tcheugui,JustinB;Grams,MorganE;Selvin,Elizabeth
通讯作者：
Selvin,Elizabeth

Sodium-Glucose Cotransporter-2 Inhibitors and the Risk of Abnormal Serum Potassium Level.

钠-葡萄糖协同转运蛋白 2 抑制剂和血清钾水平异常的风险。

DOI：
10.2215/cjn.02130221
发表时间：
2021
期刊：
Clinical journal of the American Society of Nephrology : CJASN
影响因子：
0
作者：
Hwang,YJoseph;Lyu,Beini;Chang,AlexR;Inker,LesleyA;Grams,MorganE;Shin,Jung-Im
通讯作者：
Shin,Jung-Im

Weight changes following antidiabetic mediation use: Real-world evidence from health system data.

DOI：
10.1002/osp4.600
发表时间：
2022-10
期刊：
OBESITY SCIENCE & PRACTICE
影响因子：
2.2
作者：
Lyu, Beini;Grams, Morgan E.;Inker, Lesley A.;Chang, Alex R.;Selvin, Elizabeth;Shin, Jung-Im
通讯作者：
Shin, Jung-Im

Bisphosphonate utilization across the spectrum of eGFR.

在整个 eGFR 范围内使用双膦酸盐。

DOI：
10.1007/s11657-020-0702-2
发表时间：
2020
期刊：
Archives of osteoporosis
影响因子：
3
作者：
Titan,SilviaM;Laureati,Paola;Sang,Yingying;Chang,AlexR;Evans,Marie;Trevisan,Marco;Levey,AndrewS;Grams,MorganE;Inker,LesleyA;Carrero,Juan-Jesus
通讯作者：
Carrero,Juan-Jesus