Geographic and Environmental Health Equity in Kidney Precision Medicine

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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.