Epidemiology and management of chronic kidney disease in South Asians

南亚人慢性肾脏病的流行病学和治疗

• 批准号: 8916107
• 负责人: Shuchi Anand
• 金额: $ 17.76万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8916107
• 关键词: 18 year old; Adherence; Adult; Aftercare; Age-Years; Albuminuria; Americas; Angiotensin-Converting Enzyme Inhibitors; Area; Asia; Asians; Atherosclerosis; Biometry; Blood Glucose; Blood Pressure; Body Size; Body Weight; Body mass index; Caring; Central obesity; Chicago; Chronic Disease; Chronic Kidney Failure; Communication Tools; Communities; Control Groups; Country; Data; Data Set; Databases; Diabetes Mellitus; Dietary Intervention; Education; Educational Intervention; Effectiveness; Electronic Health Record; Epidemiology; Ethnic group; Fasting; Foundations; Generations; Glycosylated hemoglobin A; Goals; Health; Health Personnel; Health Policy; Health Services Research; High Prevalence; Immigrant; Incidence; Income; India; Insulin; Insulin Resistance; Intervention; Kidney Diseases; Life; Link; Mediator of activation protein; Mentors; Metabolic syndrome; Nephrology; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Organ; Patient Care Team; Patients; Play; Population; Prevalence; Prevalence Study; Process; Proteinuria; Provider; Proxy; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk Factors; Risk Reduction; Role; Rural; San Francisco; Site; South Asian; Staging; Structure; Surveys; Training; Urine; Visceral; Waist-Hip Ratio; Work; adiponectin; alpha-Fetoproteins; base; cardiometabolic risk; care seeking; career; cohort; cost; design; epidemiology study; fasting glucose; global health; high risk; innovation; interest; lifestyle intervention; racial and ethnic; screening; skills; surveillance study; tool; waist circumference

DESCRIPTION (provided by applicant): The primary purpose of this proposal is to provide mentored guidance for Dr. Shuchi Anand as she becomes an independent clinician researcher. Dr. Anand is interested in kidney disease care in a global health context, particularly in highlighting the growing burden of chronic kidney disease (CKD) in low- and middle-income countries and in devising innovative strategies to manage CKD. Thus this proposal will study the epidemiology of CKD in South Asians and evaluate low-cost tools for its management in patients with diabetes. South Asians have recently been identified to be at high risk for insulin resistance in the form of diabetes and metabolic syndrome, with a four-fold higher prevalence and two-fold higher incidence of diabetes than U.S. whites. Yet limited data are available on one of the most important end-organ consequences, i.e., CKD. This proposal uses data from the Cardiometabolic Risk Reduction in South Asia (CARRS) study, a community-based cohort of adults living in New Delhi, Chennai, and Karachi to study the prevalence and incidence of CKD, with the hypothesis that insulin resistance will be the primary risk factor for CKD even among South Asians living in a resource-constrained setting. To evaluate the extent to which management of risk factors such as blood glucose and blood pressure plays a role in determining the burden of CKD, the study will compare CKD prevalence in CARRS with CKD prevalence in South Asians living in the U.S. (where risk factors are expected to be better managed). A pooled dataset will be created from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and the Pan Asian Cohort (PAC) Research Database to perform this analysis. In addition the study will explore which markers of body size (waist-circumference, waist-to-hip ratio, or body mass index) and of insulin resistance (fasting glucose, hemoglobin a1c, or fasting insulin levels) best predict new onset CKD among South Asians. The final aim of this proposal is to create a sub-study within an ongoing randomized control trial in five sites in rural India. The sub-study will evaluate a structured education intervention by a lay health worker in motivating patients with diabetes to seek care after undergoing a screening urine dipstick, which will be used as a tool to identify high risk (proteinuric) patients as well a to discuss the end-organ consequences of diabetes. A qualitative survey of patients and providers will also be performed to identify barriers to care. The overall goal is to report on the burden of CKD among South Asians and attempt to manage it with low-cost strategies. With this proposal, Dr. Anand will advance her epidemiology skills by working on analyses from the CARRS, MASALA, and PAC databases. She will obtain additional training in health services research via didactic coursework and on-the-ground project implementation. Throughout the process, she will receive training and guidance from experts in global health, nephrology, health policy, and biostatistics as she builds a strong foundation for a productive research career.

描述（由申请人提供）：本申请的主要目的是为Shuchi Anand博士成为一名独立的临床研究员提供指导。Anand博士对全球健康背景下的肾脏疾病护理感兴趣，特别是在低收入和中等收入国家强调慢性肾脏疾病（CKD）日益增长的负担，以及制定管理CKD的创新策略。因此，本提案将研究南亚CKD的流行病学，并评估糖尿病患者CKD管理的低成本工具。南亚人最近被确定为糖尿病和代谢综合征形式的胰岛素抵抗的高风险人群，糖尿病的患病率是美国白人的四倍，发病率是美国白人的两倍。然而，关于最重要的终末器官后果之一，即CKD的数据有限。本建议使用来自南亚心脏代谢风险降低研究（CARRS）的数据，这是一项生活在新德里、金奈和卡拉奇的以社区为基础的成人队列研究，研究CKD的患病率和发病率，假设胰岛素抵抗将是CKD的主要危险因素，即使是生活在资源受限环境中的南亚人。为了评估血糖和血压等危险因素的管理在决定CKD负担中的作用程度，该研究将比较CARRS中的CKD患病率与生活在美国的南亚人的CKD患病率（风险因素预计会得到更好的管理）。将从生活在美国的南亚人动脉粥样硬化介质（MASALA）研究和泛亚队列（PAC）研究数据库中创建一个汇总数据集来进行这项分析。此外，该研究将探索体型（腰围、腰臀比或体重指数）和胰岛素抵抗（空腹血糖、糖化血红蛋白或空腹胰岛素水平）的哪些指标最能预测南亚人新发CKD。本提案的最终目的是在印度农村五个地点正在进行的随机对照试验中创建一个子研究。该子研究将评估一项有组织的教育干预