PROJECT SUMMARY
The overall goal of this K23 Career Development proposal is to provide me with the essential mentorship and
career development necessary to become an independent investigator with expertise in women’s
cardiovascular health and kidney disease. Ischemic and non-ischemic cardiovascular disease remains the
leading cause of death among patients initiating dialysis, and the burden of cardiovascular events increases
with the progression of kidney disease. The central hypothesis is that among patients with end-stage kidney
disease (ESKD), women as compared to men, have a higher frequency of cardiovascular events and receive
suboptimal revascularization treatment strategies, which results in higher cardiovascular mortality. The goals
for the proposed study are to examine the sex differences in ischemic and non-ischemic cardiovascular events,
coronary revascularization strategies, and clinical outcomes in dialysis patients. I will develop a decision model
to determine the optimal coronary revascularization strategy for dialysis patients with coronary artery disease
and perform a focus group study to explore patients’ attitudes and barriers to coronary revascularization. My
preliminary data show a higher frequency of cardiovascular events in women versus men among the ESKD
population. The proposed cohort study leverages the infrastructure of the largest prospectively maintained
cohort of dialysis patients in the United States, with over 6 million enrollees. My study is significant because it
will fill the current knowledge gap in the interplay between sex, kidney disease, and cardiovascular disease in
patients undergoing dialysis. The proposal is innovative since it will be the first study to examine differences in
women as compared to men in cardiovascular events and revascularization strategies among dialysis patients.
I will develop a novel sex-specific decision tool to determine the optimal revascularization strategy in patients
with ESKD. This study aims to improve our knowledge so that clinicians can better counsel their patients and
modify their risk for adverse cardiovascular outcomes. New knowledge from this proposal will lead to future
studies with targeted interventions directed at reducing health disparities in patients with kidney disease to
improve cardiovascular care, especially in women. I anticipate that my findings will lead to new policy decisions
and actionable initiatives to reduce health disparities and foster more sex-inclusive cardiovascular health
planning. I propose a career development plan that combines advanced biostatistical coursework, and didactic
training in translational research methods and health equity related to understanding sex differences in
cardiovascular health among patients with ESKD. I will receive mentorship by a team of expert investigators
from disciplines in clinical epidemiology, mixed-methods research, and decision analysis research. Through
the K23 Career Development Award Program, I will generate data, and enhance knowledge and skills in
patient-oriented clinical research to submit an R01 application, and then transition to become an independent
investigator.