Racial Disparities in Chronic Kidney Disease and Vitamin D: Are they related?

描述(由申请人提供)： 我的这个职业发展奖的目标是成为慢性肾脏疾病进展中以患者为中心的研究的优秀独立研究员。慢性肾脏病(CKD)和终末期肾病(ESRD)是世界性流行病，据估计，美国有1900万慢性肾脏病患者，超过30万人接受透析治疗。非洲裔美国人和其他少数民族受到ESRD的影响不成比例，发病率几乎是白人的四倍。CKD的发病和发展的危险因素以及ESRD的种族差异的因素尚未完全阐明。维生素D具有抗增殖和免疫调节特性，是肾素-血管紧张素系统的内分泌调节剂。因此，低水平的维生素D是CKD进展的一个潜在的新的危险因素。此外，美国的非裔美国人和西班牙裔美国人的维生素D水平低于白人，这使得维生素D的差异可能是导致非裔美国人、西班牙裔和白人之间CKD进展不同的原因之一。我的研究计划的第一部分将使用妇女健康倡议的数据来探索导致再生障碍性贫血和白人维生素D水平差异的因素。然后，我将使用NHANES III死亡率和医疗保险联系的数据来评估低维生素D水平与全因和心血管特殊死亡率以及ESRD事件之间的关系。如果这些关联存在，我将评估维生素D水平的差异是否可以解释ESRD的种族差异。我的第三个目标是在患有慢性肾脏病、维生素D缺乏和蛋白尿的多民族人群中进行维生素D补充的随机临床试验，以评估维生素D水平的纠正以及蛋白尿和血压的减少。我已经证明了我的承诺和成为一名成功的临床研究员的能力，我获得了临床流行病学硕士学位，并通过个人NRSA获得了作为肾病研究员的独立资金。这笔K23奖学金将允许我通过高级正式课程、密集的指导以及随机临床试验的设计、规划和实施来发展我的职业生涯。

DESCRIPTION (provided by applicant): My goal for this career development award is to become an excellent independent investigator in patient-oriented research in chronic kidney disease progression. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are world-wide epidemics with an estimated 19 million people living with CKD and over 300,000 treated with dialysis in the United States. African-Americans and other minorities are disproportionately affected by ESRD with an incidence rate that is almost fourfold that of whites. Risk factors of initiation and progression of CKD and the factors underlying the racial disparities in ESRD have not been fully elucidated. Vitamin D has anti-proliferative and immunomodulatory properties and functions as an endocrine regulator of the renin-angiotensin system. As such, low levels of vitamin D are a potential novel risk factor for progression of CKD. In addition, African-Americans and Hispanics in the United States have lower vitamin D levels than whites, making differences in vitamin D a possible contributor to the differential CKD progression between African-Americans, Hispanics and whites. The first part of my research proposal will use data from the Women's Health Initiative to explore the factors underlying the differences in vitamin D levels between AA and whites. I will then use data from the NHANES III mortality and Medicare linkages to assess associations between low vitamin D levels and all-cause and cardiovascular-specific mortality and incident ESRD. If these associations exist, I will then evaluate whether differences in vitamin D levels may explain the racial disparities in ESRD. My third aim will be to conduct a randomized clinical trial of vitamin D repletion in a multi-ethnic population with CKD, vitamin D deficient and albuminuria to evaluate correction of vitamin D levels, and reductions in albuminuria and blood pressure. I have already proven my commitment and ability to become a successful clinical investigator by obtaining a Master's degree in Clinical Epidemiology and obtaining independent funding as a nephrology fellow through an individual NRSA. This K23 grant will allow me to develop my career through advanced formal coursework, intensive mentoring and the design, planning and conduct of a randomized clinical trial.