Geographic and Environmental Health Equity in Kidney Precision Medicine

急性和慢性肾脏疾病（CKD）通常是相互关联的，并且每种疾病都可能导致另一种疾病。两 是常见的和昂贵的，但生物标志物和治疗是不完整的。肾脏精准医学项目 （KPMP）通过获取研究方案肾脏活检的病理和 生物分子审讯本申请响应RFA-DK-20-026，建议增加 北卡罗来纳州和亚利桑那州的大学作为资源丰富的招聘网站， 与农村、黑人、拉丁裔和土著人口以及著名的健康公平中心合作， 环境卫生研究。纳入地理上不同的人口对KPMP至关重要，因为 由邻里背景和环境污染物代表的健康的社会经济决定因素 解释了CKD患病率的地理变异性。 目标1：坚持最高的安全和道德标准，同时成功招募和 保留KPMP参与者从地理，种族和种族多样化的人群， 阿基和/或CKD我们邀请了生物伦理学和健康公平方面的专家， 方法和克服征聘和留住人才的障碍。为我们的KPMP提供最高的安全性 参与者，我们已经与介入放射学合作，进行所有的研究肾活检。 目标2：与KPMP的调查人员充分接触和合作，以最大限度地提高其效率， 生产力和发现，以减少CKD和阿基的人类和经济损失为目标。 我们将遵守KPMP现有的协议，积极参与委员会和写作小组， 提供创造性的策略来排除障碍并优化KPMP内的工作流程。 目标3：通过纳入完全多样化的知识，提高KPMP科学生产力的广度 人口和获取详细的环境暴露数据，目前没有捕获。 CKD的患病率和严重程度存在地理异质性。使用新的工具，我们的网站将 提供有关CKD和阿基环境暴露的新信息， KPMP结果的解释。 总之，我们的申请建议通过人口和地理因素进一步加强KPMP。 多样化使用工具来评估邻里背景，并确定环境风险，以扩大 这些领域的研究机会对阿基和CKD的发病机制至关重要。

Acute and chronic kidney diseases (CKDs) are often interrelated, and each can predispose to the other. Both are common and costly yet biomarkers and treatments are incomplete. The Kidney Precision Medicine Project (KPMP) addresses this problem via acquisition of research protocol kidney biopsies for pathologic and biomolecular interrogation. This application responds to RFA-DK-20-026, proposing addition of the Universities of North Carolina (UNC) and Arizona (UA) as highly resourced recruitment sites enriched with rural, Black, LatinX and indigenous populations and with renowned centers in health equity and environmental health research. Inclusion of geographically diverse populations is critical to KPMP, as socioeconomic determinants of health represented by neighborhood context and environmental pollutants explain much of the geographic variability of CKD prevalence. ▪ AIM 1: To adhere to the highest safety and ethical standards, while successfully recruiting and retaining KPMP participants from geographically, racially, and ethnically diverse populations with AKI and/or CKDs. We have included experts in bioethics and health equity to inform and guide our approaches and overcome barriers to recruitment and retention. To provide the highest safety for our KPMP participants, we have partnered with interventional radiology to perform all research kidney biopsies. ▪ AIM 2: To fully engage and collaborate with investigators of the KPMP to maximize its efficiency, productivity, and discovery with the goal of reducing the human and economic toll of CKDs and AKI. We will adhere to existing protocols of KPMP, actively participate in committees and writing groups, and provide creative strategies to troubleshoot barriers and optimize workflow within KPMP. ▪ AIM 3: To enhance the breadth of KPMP scientific productivity through inclusion of fully diverse populations and acquisition of detailed environmental exposure data that are currently not captured. There is geographic heterogeneity in the prevalence and severity of CKDs. Using new tools, our site will provide new information about environmental exposures for CKDs and AKI that will broaden the interpretation of KPMP findings. In summary, our application proposes to further strengthen KPMP through demographic and geographic diversification using tools to assess neighborhood context and identify environmental exposures to expand research opportunities in these fields critical to the pathogenesis of AKI and CKDs.