Patient-Centered Approach to Exploring Protein-Energy Wasting in Dialysis

PROJECT SUMMARY/ABSTRACT Laura D. Byham-Gray, PhD, RD is an Associate Professor of Nutritional Sciences at Rutgers Biomedical and Health Sciences (RBHS) who has focused her career on teaching and conducting comparative effectiveness research (CER) in clinical nutrition. Dr. Byham-Gray is applying for this training grant in order to pursue her career goals of developing new skills in Patient-Centered Outcomes Research (PCOR), inclusive of integrating a stakeholder engagement portion to her future CER studies. Career Development Plan: Dr. Byham-Gray's training will include two years of guided mentorship to augment her research training and skills, and to acquire new knowledge and competence in CER/PCOR. Mentors [Drs. Stephen Crystal from the Rutgers Institute for Health, Health Care Policy and Aging Research (IHHCPAR) and Glenn Chertow from the Department of Nephrology at Stanford University (SU)] with collaboration from Dr. Donald Hoover, statistician from IHHCPAR and her Career Advisory Committee (Drs. Brian Strom, Chancellor of the RBHS, Riva Touger-Decker, Chair of the Department of Nutritional Sciences at RBHS, Peter Gillies, Professor in Nutritional Sciences at the Rutgers Institute for Food, Nutrition, and Health, and an incident dialysis patient from SU) will oversee Dr. Byham-Gray's career trajectory. Didactic education in CER/PCOR is planned through the University of Pennsylvania including coursework offered by the Master of Clinical Epidemiology/Master of Health Policy Programs. Experiential training will be completed in tangent with these courses. Research activities will also occur at SU, involving dialysis patients through a Deliberative Panel. Institutional Environment: RBHS (formerly the University of Medicine and Dentistry of New Jersey) has been an active leader in clinical research, conducting over 3,000 clinical studies, with 475 involving human subjects. RBHS has an increased emphasis in outcomes research, epidemiology, and population science. Dr. Byham-Gray will have protected time within her department to obtain such mentorship as well as to conduct the proposed research project. Description of Project: Dr. Byham-Gray will apply PCOR skills to an AHRQ priority population of patients diagnosed with chronic kidney disease (CKD) maintained on dialysis, who require specialized medical and nutritional care. She will explore the existing dataset from the Comprehensive Dialysis Study to examine the modifiable and unmodifiable etiological factors for protein-energy wasting (PEW) risk among incident dialysis patients and to determine the effect of PEW on patient-centered outcomes, with the intent of aiding clinicians in targeting treatment to lower the overall risk in future investigations. Using qualitative methods, the Deliberative Panel will offer perceptions and ideas on the current and future research, assuring that the proposed project as well as further work focuses on outcomes that matter the most to patients/caregivers.