# Association of diuretics with change in extracellular volume, natriuretic peptides, symptoms, and cardiovascular outcomes in CKD > **NIH VA IK2** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2022 · — ## Abstract I am a Nephrologist and junior clinical researcher at the Michael E. DeBakey VA Medical Center, an academic VA medical center affiliated with the HSR&D Center for Innovations in Quality, Effectiveness and Safety. My long-term career goal is to become an independent VA clinical researcher focused on improving cardiovascular (CV) and kidney outcomes in Veterans with chronic kidney disease (CKD). My short-term goals are to conduct initial studies to determine the effects of diuretics on relationships between extracellular volume (ECV), brain natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP), symptoms, CV hemodynamic parameters, and outcomes in Veterans with CKD, and to complete training in conducting a clinical trial, CV and cardiorenal study design, use of bioimpedance spectroscopy (BIS) measurements of ECV, and advanced scientific appraisal. To complete the proposed projects and to ensure that I have the training to compete for VA Merit Review, I have designed a comprehensive plan including hands-on mentorship, coursework, conference attendance, and experiential learning to address these specific content areas. I have assembled a diverse team of mentors dedicated to my career development to oversee the scientific and training aims of this proposal. We will use a translational science model to address our central hypothesis, that starting or increasing diuretics in Veterans with CKD is associated with changes in patient-level factors, CV physiology, and population-level outcomes. In the first study, we will determine if initiation of diuretic treatment or increase in dose is associated with changes in BNP and NT-pro-BNP, patient-reported symptom burden, and short-term hemodynamic parameters in patients with CKD stages 1-3 and elevated blood pressure, and whether these changes correlate with changes in ECV. This clinical trial will include 46 outpatients with CKD stages 1-3 and blood pressure >140/90 mmHg. ECV will be measured by BIS, which is a validated, non-invasive, painless measure of ECV. Plasma BNP and NT-pro-BNP will be measured, and patient-reported fatigue, depression, and quality of life will be quantified using validated questionnaires. Hemodynamic parameters include blood pressure, pulse pressure, total peripheral resistance index, and cardiac index measured by Non-Invasive Cardiac Output Monitoring. A transthoracic echocardiogram will measure left ventricular mass index, valvular disease, and diastolic dysfunction. At the first visit, I will initiate or increase the dose of a thiazide or loop diuretic. Study measures other than echocardiogram will be repeated 4 weeks after the intervention to determine changes in these parameters. We will compare the changes in natriuretic peptides, symptoms, and CV parameters with the change in ECV. Second, we will determine whether initiation of a diuretic vs. non- diuretic is associated with CV and kidney outcomes in patients with CKD stages 1-3 and 4-5 using a large, real- world databa... ## Key facts - **NIH application ID:** 10366684 - **Project number:** 1IK2CX002368-01A1 - **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER - **Principal Investigator:** Lucile Parker Gregg - **Activity code:** IK2 (R01, R21, SBIR, etc.) - **Funding institute:** VA - **Fiscal year:** 2022 - **Award amount:** — - **Award type:** 1 - **Project period:** 2022-01-01 → 2026-12-31 ## Primary source NIH RePORTER: https://reporter.nih.gov/project-details/10366684 ## Citation > US National Institutes of Health, RePORTER application 10366684, Association of diuretics with change in extracellular volume, natriuretic peptides, symptoms, and cardiovascular outcomes in CKD (1IK2CX002368-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10366684. Licensed CC0. --- *[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*