This NIH Mentored Patient-Oriented Research Career Development Award proposal describes a 5 year training program with the long-term goal of the candidate developing into an independent academic investigator with a research focus in hypertension in patients with chronic and end-stage kidney disease. The candidate will build on a background in clinical research developed during a comprehensive research fellowship spent studying ambulatory blood pressure and endothelial cell dysfunction in patients with intradialytic hypertension. The career development objectives are to obtain skills in designing and conducting prospective clinical research studies, learn statistical models to analyze ambulatory blood pressure in hemodialysis patients, gain experience in measuring and interpreting cardiovascular physiologic parameters including extracellular water and vascular resistance utilizing bioimpedance analysis, and participate in scholarly activities to facilitate te transition into an independent investigator. These will be applied immediately to investigating how extracellular volume and mediators of vascular resistance affect ambulatory blood pressure in patients with intradialytic hypertension and hemodialysis controls.
Aim 1 will use a case control design to compare differences in extracellular water in patients with intradialytic hypertension and hemodialysis controls.
Aim 2 will determine how extracellular volume, vasoconstrictor mediators of vascular resistance, and vascular resistance itself modify ambulatory blood pressure and the ambulatory blood pressure slope in these two groups.
In aim 3, the candidate will gain experience in designing and conducting a randomized trial by comparing the effects of carvedilol vs. prazosin on ambulatory blood pressure, vascular resistance, and mediators of vascular resistance in patients with intradialytic hypertension. The candidate will develop these skills with the support a primary mentor, 3 co-mentors (including one translational research cardiologist and one biostatistician), and a research advisory committee with extensive experience in multiple research disciplines. The candidate and his advisors are located at the University of Texas Southwestern Medical Center, a leading academic medical center with substantial physical and intellectual resources necessary for the career development of young investigators and the performance of cutting-edge research. The candidate will take advantage of numerous courses and research activities as a Clinical Research Scholar in the Department of Clinical Sciences that will promote the overall development of his career. Consistent with the candidate's long term career goals, the findings from this study can be broadened to studying hypertension in hemodialysis patients in general. Understanding the relationship between extracellular volume, vascular resistance, and ambulatory blood pressure will provide the opportunity to investigate how pharmacologic therapies affect each component and how this can improve cardiovascular outcomes in hemodialysis patients.

Public Health Relevance

In hemodialysis patients, high blood pressure increases the risk for death and complications related to heart disease. This research studies how hemodynamic changes during dialysis are associated with high blood pressure measured throughout the entire 44 hour period between dialysis treatments. Findings from this project will direct future studies that investigate which medications or interventions will most successfully lower blood pressure and reduce adverse events in hemodialysis 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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Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK-D)
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Rankin, Tracy L
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University of Texas Sw Medical Center Dallas
Internal Medicine/Medicine
Schools of Medicine
United States
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Van Buren, Peter Noel (2017) Pathophysiology and implications of intradialytic hypertension. Curr Opin Nephrol Hypertens 26:303-310
Van Buren, Peter Noel; Inrig, Jula K (2017) Special situations: Intradialytic hypertension/chronic hypertension and intradialytic hypotension. Semin Dial 30:545-552
Van Buren, Peter Noel; Inrig, Jula K (2016) Mechanisms and Treatment of Intradialytic Hypertension. Blood Purif 41:188-93
Van Buren, Peter Noel; Zhou, Yunyun; Neyra, Javier A et al. (2016) Extracellular Volume Overload and Increased Vasoconstriction in Patients With Recurrent Intradialytic Hypertension. Kidney Blood Press Res 41:802-814
Hompesch, Catherine; Ma, Tsung-Wei; Neyra, Javier A et al. (2016) Comparison of Ambulatory Blood Pressure Patterns in Patients With Intradialytic Hypertension and Hemodialysis Controls. Kidney Blood Press Res 41:240-9
Van Buren, Peter Noel (2016) Evaluation and Treatment of Hypertension in End-Stage Renal Disease Patients on Hemodialysis. Curr Cardiol Rep 18:125
Van Buren, Peter N; Lewis, Julia B; Dwyer, Jamie P et al. (2015) The Phosphate Binder Ferric Citrate and Mineral Metabolism and Inflammatory Markers in Maintenance Dialysis Patients: Results From Prespecified Analyses of a Randomized Clinical Trial. Am J Kidney Dis 66:479-88
Van Buren, Peter N; Adams-Huet, Beverley; Nguyen, Mark et al. (2014) Potassium handling with dual renin-angiotensin system inhibition in diabetic nephropathy. Clin J Am Soc Nephrol 9:295-301