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: 8679738
• 负责人: Shuchi Anand
• 金额: $ 17.89万
• 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/8679738
• 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; Diet; 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; care seeking; career; cohort; cost; design; epidemiology study; fasting glucose; global health; high risk; innovation; interest; lifestyle intervention; public health relevance; 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)：本提案的主要目的是为Shuchi Anand博士成为一名独立的临床研究员提供指导。阿南德博士对全球健康背景下的肾脏疾病护理感兴趣，特别是强调低收入和中等收入国家慢性肾脏疾病(CKD)日益加重的负担，以及设计创新战略来管理CKD。因此，这项提案将研究南亚人慢性肾脏病的流行病学，并评估用于糖尿病患者的低成本治疗工具。南亚人最近被确认为糖尿病和代谢综合征形式的胰岛素抵抗的高危人群，患病率是美国白人的四倍，糖尿病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，可用的数据有限。这项建议使用了减少南亚心脏代谢风险(CARRS)研究的数据，CARRS研究是居住在新德里、金奈和卡拉奇的一个以社区为基础的成年人队列，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，即使在生活在资源有限的南亚人中也是如此。为了评估血糖和血压等风险因素的管理在确定慢性肾脏病负担中的作用程度，这项研究将比较CARRS中的慢性肾脏病患病率与居住在美国(那里的风险因素有望得到更好管理)的南亚人的慢性肾脏病患病率。将从居住在美国的南亚人(MASLA)研究和泛亚洲队列(PAC)研究数据库中创建一个汇集的数据集来执行这项分析。此外，这项研究还将探索哪些体型(腰围、腰臀比或体重指数)和胰岛素抵抗(空腹血糖、血红蛋白A1C或空腹胰岛素水平)的标记物最能预测南亚人新发的慢性肾脏病。这项提议的最终目标是在印度农村的五个地点正在进行的随机对照试验中创建一个子研究。子研究将通过业馀人员来评估结构化教育干预 卫生工作者在鼓励糖尿病患者在接受尿检后寻求护理方面发挥了重要作用，尿检将被用作识别高危(蛋白尿)患者以及讨论糖尿病对器官的影响的工具。还将对患者和提供者进行定性调查，以确定护理障碍。总体目标是报告以下方面的负担 在南亚人中传播CKD，并试图用低成本战略来管理它。有了这项建议，阿南德博士将通过研究CARRS、Masala和PAC数据库的分析来提高她的流行病学技能。她将通过授课课程和实地项目实施获得额外的卫生服务研究培训。在整个过程中，她将接受全球健康、肾脏病、健康政策和生物统计学专家的培训和指导，为她富有成效的研究生涯奠定坚实的基础。