ABSTRACT/ PROJECT SUMMARY Dr. Junichi Ishigami, MD, MPH seeks a Mentored Research Scientist Development Award in order to obtain essential skills and mentored research experience to become an independent investigator in the field of implementation research to improve the uptake of influenza vaccination among individuals with chronic kidney disease (CKD). The research proposal details a five-year plan consisting of implementation research to improve the uptake of influenza vaccination among individuals with CKD, and advanced coursework at the Johns Hopkins Bloomberg School of Public Health under the combined mentorship of Dr. Kunihiro Matsushita, MD, PhD, and Dr. David Dowdy, MD, PhD. Influenza affects 10-35 million individuals annually in the US, resulting in up to 710,000 hospitalizations and 56,000 deaths. Vaccination against influenza is especially important for individuals with CKD due to their high risk of influenza complications (e.g., pneumonia, cardiovascular disease). Yet, we have recently reported that ~40% of adults aged ≥65 years with non-dialysis dependent CKD in the US did not get an influenza vaccine and the vaccination rate has not improved between 2005 and 2015. This indicates that additional efforts are urgently needed to improve the uptake of influenza vaccination particularly in this high risk population. However, no evidence-based implementation strategies exist to improve the uptake of influenza vaccination specifically among individuals with CKD. The proposed project will address this public health concern. The specific aims of this research proposal are 1) To determine patient and provider perceptions about influenza vaccination in nephrology care, 2) To design a theory-based vaccination program and test its feasibility in nephrology care, and 3) To evaluate the cost-effectiveness of a theory-based vaccination program in nephrology care. To address these issues, we will leverage the Chronic Renal Insufficiency Cohort (CRIC), an NIDDK-funded, ethnically-diverse, well-documented, contemporary, longitudinal cohort of 5,499 persons aged 21-74 years at baseline with a variety of CKD stages. This project will inform implementation strategies to enhance an effective influenza vaccine delivery in CKD, provide proof of concept of promoting influenza vaccination in nephrology care, and provide information on the cost- effectiveness of a theory-based vaccination program for decision-making on resource utilization. Together, this project will pave a theoretical foundation for developing cost-effective and feasible vaccination programs for individuals with CKD, which can be further extended under other funding mechanisms such as an R01. This project will make the candidate fully equipped to be an independent investigator and also will provide an evidence base for improving influenza vaccine uptake in CKD, an understudied and important clinical priority in nephrology care.