Dr. Furth, who trained in Pediatrics and Pediatric Nephrology at Johns Hopkins, is seeking this mentored award to study clinical outcomes associated with treatment choices for pediatric end stage renal disease (ESRD), complete a PhD in Clinical Investigation and transition to an independent career in clinical research. Under the mentorship of Dr. Neil Powe, she received the NIDDK Renal Disease Epidemiology Training Grant, was appointed as an Assistant Professor in the Division of Pediatrics, co-authored several published papers, developed the proposed research plan and presented several abstracts at important National Pediatrics and Nephrology meetings. Over 4,600 children and adolescents in the U.S. live with ESRD, at an annual Medicare cost of 40,000 dollars per patient year. Despite tremendous gains in survival, their """"""""outcomes"""""""" in terms of mortality, hospitalizations, and the development of comorbid conditions, remain poor. No national study has previously addressed how particular treatment regimens and clinical experience with ESRD care affect pediatric patient mortality, hospitalization, growth and educational achievement. Furthermore, reliable measures of functional outcome, as an alternative measure of treatment effectiveness, have not been systematically studied in children with ESRD. The long term objectives of this proposal are to define patient, provider and treatment factors associated with optimal clinical outcomes in pediatric ESRD, and to test the use of a generic health questionnaire assessing functional health in adolescents with ESRD. We will achieve these aims through cross- sectional and longitudinal analyses of national data from the U.S. Renal Data System. We propose to identify how treatment with hemodialysis, peritoneal dialysis or transplantation and the facility's experience with children independently affect clinical outcomes. Additionally, we will assess the responsiveness of a generic adolescent health questionnaire in assessing changes in health status over time as an alternative outcome measure. This research proposal will provide an in- depth analysis of health outcomes, and will provide valuable information regarding optimal treatment choices for children with kidney failure. During this project, Dr. Furth will gain new skills and knowledge in the sophisticated research techniques of multivariate risk adjustment, analysis of longitudinal data and psychometric assessment. The combination of observational and experimental research will provide the basis for further prospective studies in pediatric ESRD, and will give Dr. Furth the tools she needs to develop into an independent clinical investigator in a nurturing academic environment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08DK002586-04
Application #
6516712
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
Project Start
1999-04-15
Project End
2004-03-31
Budget Start
2002-04-01
Budget End
2003-03-31
Support Year
4
Fiscal Year
2002
Total Cost
$129,412
Indirect Cost
Name
Johns Hopkins University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Gerson, Arlene C; Riley, Anne; Fivush, Barbara A et al. (2005) Assessing health status and health care utilization in adolescents with chronic kidney disease. J Am Soc Nephrol 16:1427-32
Gerson, Arlene; Hwang, Wenke; Fiorenza, Jeffrey et al. (2004) Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 44:1017-23
Furth, Susan L; Arbus, Gerald S; Hogg, Ronald et al. (2003) Varicella vaccination in children with nephrotic syndrome: a report of the Southwest Pediatric Nephrology Study Group. J Pediatr 142:145-8
Furth, Susan L; Hwang, Wenke; Neu, Alicia M et al. (2003) Effects of patient compliance, parental education and race on nephrologists' recommendations for kidney transplantation in children. Am J Transplant 3:28-34
Furth, Susan L; Hogg, Ronald J; Tarver, Joyce et al. (2003) Varicella vaccination in children with chronic renal failure. A report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 18:33-8
Furth, Susan L; Stablein, Don; Fine, Richard N et al. (2002) Adverse clinical outcomes associated with short stature at dialysis initiation: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 109:909-13
Furth, Susan L; Hwang, Wenke; Yang, Ching et al. (2002) Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr Nephrol 17:450-5
Furth, Susan L; Fivush, Barbara A (2002) Varicella vaccination in pediatric kidney transplant candidates. Pediatr Transplant 6:97-100
Furth, S L; Hwang, W; Yang, C et al. (2001) Relation between pediatric experience and treatment recommendations for children and adolescents with kidney failure. JAMA 285:1027-33
Furth, S L; Alexander, D C; Neu, A M et al. (2001) Does growth retardation indicate suboptimal clinical care in children with chronic renal disease and those undergoing dialysis? Semin Nephrol 21:463-9

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