Malnutrition, Diet and Racial Disparities in CKD

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DESCRIPTION (provided by applicant): The purpose of this Mid-Career Investigator Award in "Malnutrition, Diet and Racial Disparities in CKD" by Kamyar Kalantar-Zadeh, MD, MPH, PhD, Associate Professor-in-Residence of Medicine, Pediatrics and Epidemiology at UCLA Schools of Medicine & Public Health, is to provide him with significant protected time to continue and expand his ongoing patient-oriented research with heightened focus on mentoring early-career investigators in several UCLA related campuses including Harbor-UCLA and Charles-Drew University. These centers provide care to underserved and indigent populations and minorities who suffer from CKD and who require dialysis to survive. African Americans and Hispanics are vastly overrepresented by 3.6 and 1.5 times greater than non-Hispanic Whites, respectively, among US dialysis patients. Whereas the 5-year survival of dialysis patients is <35%, with the highest mortality among malnourished patients, minorities exhibit lower dialysis mortality. Discovering the roots of CKD racial survival disparities and their link to nutritional status and dietary barriers can have major clinical and public health implications. PI hypothesizes that these disparities are due to distinct pathophysiologic mechanisms related to nutritional status and dietary intake across race; whereas 2 alternative hypotheses related to bone-and-mineral disorders and psychosocial and coping status will also be examined. PI proposes a 5-year patient-oriented, prospective study with repeated measures in a dynamic cohort of 1,050 hemodialysis (HD) patients (1/3 African Americans & 1/3 Hispanics), in collaboration with Southern California DaVita dialysis clinics. Nutritional status, dietary intake, psychosocial status & quality of life will be assessed longitudinally. Clinical events and survival will be followed, and specimens for ongoing and future ancillary studies will be stored. In a substudy of 360 subjects additional tests of body composition and dietary intake will be performed at GCRC. Race/ethnicity specific risk-stratification scores will be develop- ed and validated in a national retrospective cohort of over 100,000 HD patients. This K24 award with proposed cohort study will allow PI to achieve the following goals: (1) Continue and expand his productive activities and capabilities as a mentor and facilitator of training of new investigators in the fields of CKD nutrition & disparities by continuing his liaison with faculty across several campuses, schools and departments within UCLA system including Depts. of Medicine and Pediatrics, Charles-Drew Univ., and UCLA Public Health. (2) Continue and expand his credible efforts in increasing the availability of research participation to minority populations with CKD in Southern California; and (3) Continue to develop a relatively new area of CKD disparity and nutrition research specifically through continued support of the DaVita Clinical Research both in Southern California and across the nation by examining the cohort of Southern dialysis patients and national dialysis cohorts. The data collected and hypotheses generated throughout this 5-year cohort study will be utilized to power additional clinical studies by early career investigators and mentees under Dr. Kalantar to improve on patient care. PUBLIC HEALTH RELEVANCE: Examining racial and ethnic disparities in chronic kidney disease (CKD) and their relationship to nutritional status, diet and outcomes in dialysis patients may lead to developing more effective strategies to improve outcomes in dialysis population, other 20 million Americans with CKD, and another 30 to 40 million people who suffer from chronic disease states and wasting disorders including chronic heart failure, chronic lung or liver diseases, terminal malignancy, AIDS, advanced age, and other conditions with cachexia. Training and mentoring early-career investigators in CKD disparities and kidney disease nutrition will enhance these important plans.