This is an application for a K23 award for Dr. Nisha Bansal, a nephrologist at the University of California, San Francisco. Dr. Bansal is establishing herself as a young investigator in clinical research of cardiovascular disease and hypertension in chronic kidney disease. This K23 award will provide Dr. Bansal with the support necessary to accomplish the following goals: (1) to investigate the impact of blood pressure in patients during the transition between chronic kidney disease and end-stage renal disease;(2) to implement advanced biostatistical methods in clinical studies;(3) to work with a large multi-center cohort study;and (4) to develop an independent clinical research career. To achieve these goals, Dr. Bansal has assembled a mentoring team comprised of a primary mentor, Dr. Chi-yuan Hsu, Division Chief in Nephrology at UCSF, who conducts clinical research on the epidemiology and complications of chronic kidney disease, and three co-mentors and one scientific advisor: Dr. Alan Go, an expert on cardiovascular disease health services research and clinical epidemiology in chronic kidney disease;Dr. Elyse Foster, Director of the UCSF Adult Echocardiography Laboratory;Dr. Charles McCulloch, an authority in the use of statistical methods for longitudinal data analysis;and Dr. Raymond Townsend, who has expertise in hypertension and pulse wave analysis in chronic kidney disease. Cardiovascular disease is the leading cause of mortality in chronic kidney disease. Dr. Bansal's research will study the impact of blood pressure on cardiovascular disease and mortality during the transition between chronic kidney disease and end-stage renal disease (Aim 1);the association between central aortic pressures and outcomes during this transition period (Aim 2);the association between aldosterone, blood pressure and outcomes during the transition between chronic kidney disease and end-stage renal disease (Aim 3);and the impact of the use of anti-hypertension medications on outcomes during this transition period (Aim 4). To achieve these aims, Dr. Bansal will utilize a unique group of patients with chronic kidney disease assembled as part of the NIDDK-funded Chronic Renal Insufficiency Cohort (CRIC), a national study composed of 7 clinical centers. She will utilize advanced multivariate statistical analyses to accomplish these aims. This research will form the basis for a cohort study to investigate the impact of blood pressure in patients with heart failure and advanced chronic kidney disease, to be proposed in an R01 grant application before the end of the K award.

Public Health Relevance

Improved understanding of the impact of blood pressure, measurement of blood pressure, and determinants of blood pressure in patients with advanced stages of kidney disease is critical to improve long-term cardiovascular complications and survival in this high-risk group of patients.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Rankin, Tracy L
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Bansal, Nisha (2016) Use of Oral Anticoagulation for Patients with ESRD on Hemodialysis with Atrial Fibrillation: Verdict 1. Clin J Am Soc Nephrol 11:2093-2094
Bansal, Nisha; McCulloch, Charles E; Lin, Feng et al. (2016) Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease. Kidney Int 90:1348-1356
Hsu, Raymond K; Chai, Boyang; Roy, Jason A et al. (2016) Abrupt Decline in Kidney Function Before Initiating Hemodialysis and All-Cause Mortality: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 68:193-202
Bansal, Nisha; Katz, Ronit; Himmelfarb, Jonathan et al. (2016) Markers of kidney disease and risk of subclinical and clinical heart failure in African Americans: the Jackson Heart Study. Nephrol Dial Transplant 31:2057-2064
Siew, Edward D; Parr, Sharidan K; Abdel-Kader, Khaled et al. (2016) Predictors of Recurrent AKI. J Am Soc Nephrol 27:1190-200
Bansal, Nisha; Lin, Feng; Vittinghoff, Eric et al. (2016) Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Kidney Dis 67:227-34
Zhang, Xuehan; McCulloch, Charles E; Lin, Feng et al. (2016) Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR. Clin J Am Soc Nephrol 11:1574-81
Bansal, Nisha; Carpenter, Myra A; Weiner, Daniel E et al. (2016) Urine Injury Biomarkers and Risk of Adverse Outcomes in Recipients of Prevalent Kidney Transplants: The Folic Acid for Vascular Outcome Reduction in Transplantation Trial. J Am Soc Nephrol 27:2109-21
Zhang, Xuehan; Bansal, Nisha; Go, Alan S et al. (2015) Gastrointestinal symptoms, inflammation and hypoalbuminemia in chronic kidney disease patients: a cross-sectional study. BMC Nephrol 16:211
Bansal, Nisha; Katz, Ronit; De Boer, Ian H et al. (2015) Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. Clin J Am Soc Nephrol 10:363-71

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