Institution: The Regents of the University of California
Grant: Sharon Anderson Research Fellowship Award (2019)
Project Title: Screening Strategies for Chronic Kidney Disease in US Populations
How would you sum up your research in one sentence?
We will use decision analysis to model the impact of screening for chronic kidney disease (CKD) followed by early CKD management on the incidence of kidney failure, cardiovascular events, and mortality.
Provide a brief overview of the research you will conduct with help from the grant.
Screening for CKD can potentially decrease kidney disease-related morbidity and mortality via early diagnosis and use of evidence-based therapies. However, whether patients should be screened for CKD remains highly controversial. We aim to evaluate the potential benefits of screening for CKD in different subpopulations by developing a decision analysis model that includes kidney parameters and outcomes. We will derive inputs for the model using pooled longitudinal cohort data, and determine individualized probabilities of prevalent CKD and CKD progression based on patient demographics and risk factors. We will then estimate the impact of selective CKD screening strategies using Markov modeling. Upon early identification of CKD, we will model the effect of treatment with ACEi/ARBs, statins, and intensified blood pressure control on the incidence of end-stage renal disease, cardiovascular events, and mortality.
What impact do you hope your research will have on patients?
The results of this research will guide patient selection for CKD screening. Currently, patients with diabetes are recommended to be screened yearly for kidney disease, however there may be other high-risk groups that would benefit from screening and early CKD detection.
What are your short and long-term career goals?
My career goal is to study population health in CKD and inform quality measurement and CKD care delivery. At the end of the grant period, I hope to determine from our model which populations would benefit most from screening for CKD. In other ongoing research projects, I am examining temporal trends and predictors of high quality CKD care. In 5 years, I hope to develop an evidence base to inform the design of new CKD-specific quality measurement. In 10 years, I hope to work with health systems, national professional organizations, and payers on CKD care delivery.
What inspired you to focus your research in this area?
I was inspired to focus my research in nephrology because there is a lack of attention to kidney disease. Both patients and clinicians have low awareness of CKD, which can result in delayed nephrology referral. On the other hand, nephrologists may be currently seeing patients at low risk for progression, when their time could be better spent on higher acuity patients. With the electronic health record, we now have the tools to develop a systematic approach and improve the care of CKD at the population level. By detecting CKD in high-risk patient populations, risk stratifying patients, and intensifying care in late-stage CKD, we can improve outcomes in this population.
What are the major challenges to beginning a career in nephrology research today?
I am fortunate to have incredible mentors who model a successful clinical research path in nephrology. Intensive research mentorship and training have been crucial for me to develop the skills and research foundation for a career in nephrology research.
What advice would you give to others to encourage them to apply for this grant funding?
Developing the grant proposal was an excellent way to crystalize thinking and catalyze the start of the research project.
Something you may not know about me is…
I acquired my love of learning from my grandfather, who immigrated to this country from India in 1963 in pursuit of higher education.
In my free time I like to…
Hike in San Francisco, read, and engage in discussion on NephTwitter (@LTummalapalli).