Institution: University of Arkansas for Medical Sciences
Grant: Joseph V. Bonventre Career Development Grant (2018)
Project Title: A Mechanistic Study in Patients with Non-Dialysis Chronic Kidney Disease to Investigate Altered Platelet Response to Antiplatelet Therapy (CKD-Platelet Study)
How would you sum up your research in one sentence?
CKD-Platelet study is a mechanistic study in stages 4-5 CKD that is critical to understand and improve the disproportionately high risk of thrombotic cardiovascular events. Completion of the proposed studies will advance the understudied field of platelet dysfunction in advanced CKD, while elucidating novel mechanisms underlying the poor efficacy of antiplatelet therapy in this population.
What inspired you to focus your research in this area?
Despite treatment with antiplatelet therapies and coronary/vascular interventions, CKD patients continue to have excessive risk for future thrombotic cardiovascular events and death. These patients are more likely to die from thrombotic events than progress to dialysis dependence. This is an understudied area of research.
What impact do you hope your research will have on patients?
No randomized controlled trials exist to establish the efficacy of ticagrelor and its potential benefit over clopidogrel in this high risk population. In addition, there are no randomized controlled studies to compare antiplatelet effects of ticagrelor in patients with advanced CKD compared to (1) those treated with clopidogrel, and; (2) controls with normal kidney function. Furthermore, mechanisms for the poor efficacy of antiplatelet therapy in patients with advanced CKD remain to be established. Studies that do exist are limited by lack of controls, high dropout rate, lack of randomization or blinding, or failure to enroll stages 4-5 CKD patients, precisely those who are at excessive risk of thrombotic cardiovascular events and die even before starting chronic dialysis. CKD-Platelet study will address these knowledge gaps and lay ground work for future studies to determine whether ticagrelor, a newer P2Y12 inhibitor, is efficacious and improves outcomes in advanced CKD, the sub-group in which multiple expensive medical interventions have thus far failed to improve outcomes.
What are your short- and long-term career goals?
My overall career goal is to become an independent investigator in clinical research, studying platelet aggregability in CKD to explain higher prevalence of thrombotic and bleeding events in CKD patients treated with anti-platelet agents. My long-term objective is to better understand these disease processes through patient-oriented research to reduce the disproportionately large burden of cardiovascular morbidity and mortality among CKD patients.
What has surprised you most about your career?
Conducting research has made me a critical thinker and a good listener and thus a better clinician.
Describe the importance of having grant funding available through the ASN Foundation.
I am very thankful to have received this prestigious award. Getting this award confirms the significance of the project and the research question. It has moved my career one step closer towards my career goals. Hopefully, at the end of the award, I will have interesting results to publish and several more questions to ask for future work. The award will enable me to complete the project in the duration of my protected time and experience the excitement of making a new observation, pursuing my research question, designing my own human trial, and bringing it to fruition.
Something you may not know about me is…
I never knew that I wanted to pursue a research career until the career plan formalized during the fellowship training under excellent mentorship.