Chi-yuan Hsu, MD, MSc is applying to renew his Mid-career Investigator Award in Patient Oriented Research (K24) in order to buttress his original research and mentorship efforts. The focus of the new research to be specifically supported by this K24 is incident end-stage renal disease (ESRD). A long-standing underlying theme of Dr. Hsu's research has been chronic kidney disease (CKD), including the transition from CKD to ESRD, which leads to his current interest in incident ESRD. This proposal addresses how we currently characterize new ESRD patients, how the reported number of new ESRD cases may be heavily influenced by threshold to initiate renal replacement therapy (RRT) and how early outcomes among incident ESRD patients are related to pre-ESRD clinical events.
Aim 1 : To determine the accuracy of how incident ESRD patients are currently characterized.
Aim 2 : To quantify how the number of incident ESRD patients vary by the threshold and timing of initiation of chronic dialysis.
Aim 3 : To better understand early outcomes among incident ESRD patients, including early death and recovery, and how they are related to pre-ESRD clinical events. Dr. Hsu has a very strong prior track record of mentorship and works within the rich, supportive and collegial institutional environment at UCSF. Continued K24 funding will permit Dr. Hsu to spend more time on research and mentoring and less time on administrative and clinical work.

Public Health Relevance

Although most patients with end-stage renal disease had preceding chronic kidney disease, much is unknown about the critical transition from chronic kidney disease to end-stage renal disease. More complete understanding of this transition will enable physicians and patients to make more informed choices regarding whether and when to initiate dialysis, provide high-quality evidence to optimize the structure of the healthcare delivey system, and allow more sophisticated assessment of quality of care.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Study Section
Special Emphasis Panel (ZDK1)
Program Officer
Abbott, Kevin C
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Lee, Benjamin J; Johansen, Kirsten L; McCulloch, Charles E et al. (2018) Potential Impact of Medicare Payment Policy on Misclassification of Dialysis-Requiring Acute Kidney Injury as ESRD: A National Temporal Trend Analysis. Am J Kidney Dis 72:311-313
Ku, Elaine; Kopple, Joel D; Johansen, Kirsten L et al. (2018) Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality. Am J Kidney Dis 71:657-665
Lee, Benjamin J; Hsu, Chi-Yuan; Parikh, Rishi V et al. (2018) Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study. BMC Nephrol 19:134
Tuot, Delphine S; McCulloch, Charles E; Velasquez, Alexandra et al. (2018) Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial. Am J Kidney Dis 72:168-177
Lee, Benjamin J; Go, Alan S; Parikh, Rishi et al. (2018) Pre-admission proteinuria impacts risk of non-recovery after dialysis-requiring acute kidney injury. Kidney Int 93:968-976
Bansal, Nisha; Roy, Jason; Chen, Hsiang-Yu et al. (2018) Evolution of Echocardiographic Measures of Cardiac Disease From CKD to ESRD and Risk of All-Cause Mortality: Findings From the CRIC Study. Am J Kidney Dis 72:390-399
Sharief, Shimi; Hsu, Chi-Yuan (2017) The Transition From the Pre-ESRD to ESRD Phase of CKD: Much Remains to Be Learned. Am J Kidney Dis 69:8-10
Ku, Elaine; Gassman, Jennifer; Appel, Lawrence J et al. (2017) BP Control and Long-Term Risk of ESRD and Mortality. J Am Soc Nephrol 28:671-677
Lee, Benjamin J; Hsu, Chi-Yuan (2017) Acute kidney injury is important in the hospital and afterward. J Hosp Med 12:126-127
Ku, Elaine; Bakris, George; Johansen, Kirsten L et al. (2017) Acute Declines in Renal Function during Intensive BP Lowering: Implications for Future ESRD Risk. J Am Soc Nephrol 28:2794-2801

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