Promoting Evidence-Based Chronic Kidney Disease Care among Hispanics/Latinos with Type 2 Diabetes - ABSTRACT Hispanic/Latino individuals (Hispanics) face a higher burden of chronic kidney disease (CKD) progression compared to their non-Hispanic White counterparts and are more likely to develop kidney failure requiring dialysis, due in part to the prevalence of type 2 diabetes (T2D). With 50% of US Hispanics expected to develop T2D, proper CKD screening using annual urine albumin-to-creatinine ratio (UACR) is vital for early detection and management. However, less than 25% of eligible patients receive an annual UACR, with even lower rates among Hispanics. Lack of UACR screening limits the use of evidence-based therapies like RAAS inhibitors, SGLT2is, GLP-1 RAs, and ns-MRAs, leading to low prescribing rates of these treatments in Hispanics with T2D. Barriers identified to optimal care include high co-pays, time constraints, language barriers, and fear of side effects. Our Riñones Dulces (“Sweet Kidneys”) intervention, a clinician-facing intervention, incorporating recommendations from clinical and pharmacy champions, increased UACR screening by 59% and SGLT2i or GLP-1 RA prescribing by 37% in our pilot trial. Despite these encouraging results, patient hesitancy remained a challenge. Increasing Hispanic patient activation, associated with better medication adherence and outcomes, could address this. Community health workers (CHWs), trusted community members sharing language and culture, can help overcome patient-level concerns. Our project aims to: (1) identify multi-level perspectives on CKD screening and treatment via interviews with Hispanic patients and caregivers; (2) present these factors to a community advisory board to optimize CHW integration in Riñones Dulces intervention; and (3) pilot test the intervention in a Hispanic-serving health system, assessing feasibility and accessibility and secondarily examining clinical outcomes. This project will enhance my skills in community-based participatory research, qualitative study design, and clinical trial design using an implementation framework. My long-term career goal is to improve Hispanic kidney health via community engagement and the development and implementation of sustainable interventions that can be seamlessly integrated into clinical settings. My career development will take place at Duke University School of Medicine, within the Division of Nephrology and the Department of Medicine, and the Duke Clinical Research Institute (DCRI). Duke offers numerous resources for career development, including access to advanced research facilities and a collaborative environment that fosters interdisciplinary research. The institution provides various training programs, workshops, and seminars focused on research methodologies, grant writing, and professional development. At the DCRI, I benefit from mentorship and networking opportunities with leading clinical researchers. Regular meetings with my multidisciplinary mentorship team will guide me through the design and implementation of research studies, data analysis, and disseminating findings to the scientific community. The support from Duke's robust infrastructure and experienced faculty will well-position me to develop into an independent clinical investigator.
