PROJECT SUMMARY This application is for a K24 Midcareer Investigator Award in Patient-Oriented Research for Dr. Sankar Navaneethan. He is a Professor of Medicine and Director of Clinical Research in the Section of Nephrology, at Baylor College of Medicine. Dr. Navaneethan’s research projects have focused on improving cardiovascular and kidney outcomes for those with and at risk of chronic kidney disease (CKD). He has extensive experience in epidemiological investigations, clinical trials, and systematic reviews. Over the past decade, he has mentored trainees at different levels including medical students, residents, fellows, and junior faculty on various patient-oriented research studies. Current proposal would help him achieve following goals: a) dedicate additional time to mentor young investigators in various patient-oriented research projects related to cardiovascular disease in kidney disease, b) learn new skills in mentoring skills through both formal courses and workshops and interactions from mentors within and outside his institution, c) enhance ongoing patient- oriented research activities in obesity and impact of other metabolic diseases on cardiovascular disease in CKD population, d) to identify new scientific areas of patient-oriented research that are critical to improvement in cardiovascular outcomes of CKD population, and e) to develop leadership skills. Proposed research projects by the applicant over the 5-years would help understand the uptake of and barriers in the adoption of cardio- kidney protective medications among those with kidney disease and investigate the potential role of sodium- glucose cotransporter-2 inhibitors (SGLT2i) in improving outcomes of those with pulmonary hypertension. These projects would utilize and expand PI’s current research infrastructure and provide data for future interventional studies. Aim of the first project is to study the pattern of initiation and uptake of SGLT2i and glucagon-like peptide-1 receptor agonists (GLP-1RA) among those with kidney disease using data collected from the Veterans Affairs health system. Objectives of the second project is to conduct a pilot non-randomized study to examine the effects of SGLT2i on pulmonary artery pressure in those with CKD.