application) The prevalence of end-stage renal disease (ESRD) continues to increase, and mortality among ESRD patients remains high. The principal hypothesis of this proposal is that care of patients with chronic renal failure prior to ESRD (pre-ESRD) is sub-optimal, and this adversely influences outcomes after initiation of ESRD therapy, such as morbidity, mortality and cost. The research will include a macro viewpoint using data from large databases such as the United States Renal Data System (USRDS) and Health Care Financing Administration (HCFA), and a micro viewpoint using detailed primary data collection at a single tertiary care hospital--New England Medical Center (NEMC). USRDS and HCFA files will be used to determine the prevalence and predictors of malnutrition, anemia, late initiation of dialysis and delayed referral to the nephrologist, and their impact on subsequent clinical variables. Separate analyses of pediatric and transplant patients will be undertaken, and compared with dialysis patients. NEMC data will be used to study the impact of delayed nephrology referral and delayed vascular access placement on hospitalization and cost. The results of this proposal are expected to provide important information regarding pre-ESRD care, and for the development of strategies to improve ESRD outcomes. The principal investigator has designed a comprehensive series of studies to evaluate the hypotheses enunciated in this proposal, and is well qualified to carry them through to completion. In addition to a combined fellowship in Adult and Pediatric Nephrology, she holds a Master's degree in Epidemiology. She is mentored by investigators with extensive experience in clinical investigation and advised by a panel of world leaders in epidemiology, clinical trials and health services research. Within a limited time, she and her mentor have put together an infrastructure tailored to achieve the goals of this proposal. The practical experience from the research proposed, and the comprehensive education program outlined are expected to build on the candidate's current skills and experience, and facilitate her transition to an independent investigator in Pediatric and Adult Renal epidemiology.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
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Tufts University
United States
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Gill, John S; Abichandani, Rekha; Khan, Samina et al. (2002) Opportunities to improve the care of patients with kidney transplant failure. Kidney Int 61:2193-200
Kazmi, W H; Kausz, A T; Khan, S et al. (2001) Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 38:803-12

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