American Indian Chronic Renal Insufficiency Cohort Study (AI-CRIC)

项目主任/主要研究者（最后，第一，中间）：Shah，Vallabh O和Unruh Mark 尽管与美国其他种族/人种相比， 美洲印第安人（AI）仍然很少受到研究CKD的研究人员的关注。例 是审评委目前的研究，在这项旗舰研究中，不到1%的参与者是认可机构。的危险因素 糖尿病肾病是该人群中CKD的主要形式，包括以下传统风险因素： 高血糖、高血压、遗传等因素，也有接触各种持久性 环境污染物CKD在认可机构中的分布及决定因素尚未充分研究， 关于CKD在AI中的进展以及 在这些人群中，CKD背景下的心血管疾病（CVD）。这是一个紧迫的问题， 人工智能社区的公共卫生影响以及相对缺乏正在进行的研究。 为了解决原住民社区的CKD负担，我们成立了一个研究者联盟， 在糖尿病、心血管和肾脏等慢性疾病的研究方面拥有丰富的经验 美国西南部的AI疾病。我们提出的对500名AI进行的CRIC辅助队列研究（AI-CRIC）将迅速 提高我们对CKD进展的潜在风险因素以及这种疾病的范围的理解 在AI中。这项建议利用了审评委目前的研究，并纳入了审评委下一个审评阶段的计划活动。 研究阶段-“CRIC 2018”-通过实施当代CRIC肾脏和心血管方案 测量和结果。拟议的前瞻性队列研究的总体目标是准确评估 AI中CKD/CVD进展率比其他种族/民族群体更高的程度 并将清洁发展机制与潜在的环境污染水平联系起来， 以及居住在美国西南部的人工智能特有的职业暴露。为了更好地理解自然 在这一高风险人群中有CKD/CVD病史，AI-CRIC将实施CRIC 2018年门诊方案， 使用移动的健康监测肾功能和损伤沿着评估CVD亚表型 技术.我们将通过以下具体目标实现这些总体目标： 具体目标1：对西南地区AI的CKD队列进行纵向研究，以确定 CKD和CVD进展，并比较AI和其他 在审评委中有代表的人口; 具体目标2：对肾功能和损害进行动态监测，并评价其与 暴露数据; 具体目标3：使用移动的健康技术进行CVD亚表型分析并评估其关系 暴露数据。 这项建议利用了审评委正在进行的数据收集和研究的专门知识，以弥补一个空白 我们对慢性肾脏病在人工智能中进展的理解。最终，AI-CRIC将迅速告知我们的理解， CKD的负担，并提供降低死亡率的干预措施。重要的是，审评委执行机构既处理 《2020年健康人》的总体目标是增加公平和减少差距， 美国肾脏病学会。 OMB编号0925-0001/0002（2018年1月批准至2020年3月31日修订版）页码续页格式页码

Program Director/Principal Investigator (Last, First, Middle): Shah, Vallabh O and Unruh Mark Despite experiencing high levels of kidney disease compared to other ethnic/racial groups in the United States, American Indians (AIs) continue to receive relatively little attention from researchers studying CKD. An example is the current CRIC study, where less than 1% of participants in this flagship study are AIs. Risk factors for diabetic kidney disease, the predominant form of CKD in this population, include the traditional risk factors of hyperglycemia, hypertension, and inheritance, but also other factors such as exposure to various persistent environmental pollutants. The distribution and determinants of CKD among AIs has been understudied, leaving many questions unanswered about the progression of CKD among AIs, as well as the prevalence of cardiovascular disease (CVD) in the setting of CKD among these populations. This is an urgent issue given the public health impact in AI communities and the relative lack of ongoing research. To address this burden of CKD in Native communities we have formed a consortium of investigators with extensive experience in conducting research of chronic diseases including diabetes, cardiovascular and kidney disease in AIs of Southwestern US. Our proposed CRIC ancillary cohort study of 500 AIs (AI-CRIC) will rapidly improve our understanding of both potential risk factors for CKD progression, as well as the scope of this disease among AIs. This proposal leverages the current CRIC study and incorporates the planned activities of the next phase of the study – “CRIC 2018” – by implementing contemporary CRIC protocols for kidney and cardiovascular measurement and outcomes. The overall goal of the proposed prospective cohort study is to precisely assess the extent to which there are higher rates of CKD/CVD progression in AIs than in other racial/ethnic groups based on standardized definitions used throughout CRIC and relate CKD to the levels of potential environmental and occupational exposures unique to AIs residing in the American Southwest. To better understand the natural history of CKD/CVD in this high-risk population, AI-CRIC will implement the CRIC 2018 protocol of ambulatory monitoring of kidney function and damage along with evaluations of CVD sub-phenotypes using mobile health technologies. We will address these overarching goals with the following specific aims: Specific Aim 1: Conduct a longitudinal study of a CKD cohort of southwest AIs to identify unique risk factors for CKD and CVD progression and compare CKD and CVD event rates and risk factors between AI and other populations represented in CRIC; Specific Aim 2: Conduct ambulatory monitoring of kidney function and damage, and evaluate its relationship with exposure data; Specific Aim 3: Conduct CVD sub-phenotyping using mobile health technologies and evaluate its relationship with exposures data. This proposal takes advantage of the ongoing data collection and expertise of the CRIC study to address a gap in our understanding of CKD progression among AI. Ultimately, AI-CRIC will rapidly inform our understanding of the burden of CKD and provide disparity-reducing interventions. Importantly, the AI-CRIC addresses both an overarching goal of Healthy People 2020 to increase equity and reduce disparities and a priority issue for the American Society of Nephrology. OMB No. 0925-0001/0002 (Rev. 01/18 Approved Through 03/31/2020) Page Continuation Format Page