Maximizing The Benefit of Therapy in CKD

最大化 CKD 治疗的益处

• 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
• 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

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 这笔赠款的第一阶段旨在生成证据，以促进适当，安全和有效的使用 肾功能范围内的药物。我们建立了一个专门的药物ePidemiology小组 并研究了超过500万患者的肾小球滤过率（GFR）的药物使用 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，血管紧张素转化酶（ACE）抑制剂，血管紧张素受体阻滞剂 （ARBS），螺内酯和瑞士伐他汀等。我们确定了指南申请的巨大差距 监测和医疗管理，例如在患者中对蛋白尿的普遍承诺 糖尿病和高血压。 在此续签应用中，我们扩展了先前的研究人群，包括其他大型卫生系统 覆盖大约2500万患者，具有肾功能措施。我们将当前数据合并到 可以研究新的药物类别，例如葡萄糖共转运蛋白-2抑制剂 （sglt2-is）。我们将调查团队的专业知识扩展到包括实施科学领域的领导者和 临床决策支持，允许将调查结果转换为当地电子卫生系统。 该应用程序的总体前提是，通过使用销售后的现实世界数据，我们可以提供 为患有慢性肾脏疾病（CKD）患者或有风险的患者提供最佳护理实践的基本证据。 使用sglt2-is作为主要示例，我们首先建议识别护理差距，量化数量 未接受SGLT2-I的患者建议根据临床实践指南进行此操作。接下来，我们 通过仔细评估 个人患者特征的风险和益处。最后，我们制定并完善临床决定 支持实时识别高危患者的支持工具，这些患者缺乏SGLT2-I治疗。总而言之 简化提供者决策并优化患有或处于危险的患者的医疗治疗的总体目标 对于CKD，此续签申请提议识别护理的差距，优化目标人群以实现有益 医疗疗法，并将知识转化为患者护理。 。

项目成果

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
• 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
• 作者: Wallace,AmeliaS;Chang,AlexR;Shin,Jung-Im;Reider,Jodie;Echouffo-Tcheugui,JustinB;Grams,MorganE;Selvin,Elizabeth
• 通讯作者: Selvin,Elizabeth

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

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
• 作者: Hwang,YJoseph;Lyu,Beini;Chang,AlexR;Inker,LesleyA;Grams,MorganE;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