MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKD

项目摘要 这个职业生涯中期的研究者奖的目的是更新，题为“营养不良，饮食和种族 CKD的差异（MADRAD）”，作者：Kamyar Kalantar-Zadeh，医学博士，公共卫生硕士，儿科医学教授 加州尔湾医学院和加州大学洛杉矶分校公共卫生学院的公共卫生和公共卫生， 为他提供重要的保护时间，以继续和扩大他正在进行的以病人为导向的研究 在加州的几所大学， 退伍军人事务附属校园在南加州。这些中心为服务不足的人提供照顾， 患有CKD并需要透析才能生存的贫困人群和少数民族。在美国， 非裔美国人和西班牙裔美国人的终末期肾病（ESRD）患病率显著较高 (3.5和1.5倍，分别高于非西班牙裔白人。虽然终末期肾病的5年总生存率 患者的死亡率低于40%，在营养不良患者中观察到的死亡风险最高， 透析患者的死亡率较低。发现CKD种族生存差异的根源以及 营养状况和饮食因素对这些差异的贡献可能具有重大的临床和公众影响。 健康影响。 PI假设这些差异是由于与以下相关的不同病理生理机制所致： 不同种族/民族的营养状况和饮食摄入。与以下方面相关的几个备选假设 遗传多态性、骨和矿物质疾病、精神健康和 心理社会因素和透析治疗特征也将被检查。PI提出了一个五年期 一项在1,500例血液透析患者的动态队列中进行重复测量的前瞻性患者导向研究 (HD)患者（1/3非洲裔美国人和1/3西班牙裔），与南加州透析诊所合作。 营养状况、饮食摄入、心理社会状况、生活质量、临床事件和生存率将被 纵向评估。还将检查遗传因素，如APOL 1风险等位基因，并对生物标本进行检测。 用于将来的辅助研究。在一项包含360名受试者的子研究中， 并进行饮食摄入。将制定人种/种族特定风险分层评分， 在超过150，000例HD患者的国家回顾性队列中进行了验证。 K24奖对这项前瞻性研究的支持将使PI实现以下目标：（1） 作为职业生涯早期的导师和促进者，继续扩大他的生产活动和能力 通过利用他在几个领域的网络关系， 校园和中心，包括加州大学系统及其医学系， 儿科，南加州的凯撒医疗机构，加州大学洛杉矶分校公共卫生部，洛杉矶和橙子县卫生部 （2）继续扩大他在增加少数民族人口参与方面的持续努力 在整个南加州的CKD研究研究;和（3）继续他的创新领域的培养， 通过有前途的早期职业调查人员进行CKD差异和营养研究， 合作者在南加州。本5年队列研究期间生成的数据和假设将 用于促进Kalantar博士指导下的学员进行更多以患者为导向的研究，以改善患者 结果。

Project Summary The purpose of the renewal of this mid-career investigator award titled, “Malnutrition, Diet and Racial Disparities in CKD (MADRAD)” by Kamyar Kalantar-Zadeh, MD, MPH, PhD, Professor of Medicine, Pediatrics and Public Health at the University California Irvine School of Medicine and UCLA School of Public Health, is to provide him with significant protected time to continue and expand his ongoing patient-oriented research endeavors with heightened focus on mentoring early-career investigators in several University of California and Veterans Affairs-affiliated campuses in Southern California. These centers provide care to underserved, indigent populations and minorities who suffer from CKD and who require dialysis for survival. In the US, African Americans and Hispanics have a substantially higher prevalence of end-stage renal disease (ESRD) (3.5 and 1.5 times higher, respectively) than non-Hispanic Whites. While the overall 5-year survival of ESRD patients is less than 40%, with the highest mortality risk observed among malnourished patients, minority dialysis patients exhibit lower mortality. Discovering the roots of CKD racial survival differences and the contribution of nutritional status and dietary factors to these disparities may have major clinical and public health implications. The PI hypothesizes that these disparities are due to distinct pathophysiologic mechanisms related to nutritional status and dietary intake across race/ethnicity. Several alternative hypotheses related to racial/ethnic differences in genetic polymorphisms, bone and mineral disorders, mental health and psychosocial factors, and dialysis treatment characteristics will also be examined. The PI proposes a 5-year prospective patient-oriented research study with repeated measures in a dynamic cohort of 1,500 hemodialysis (HD) patients (1/3 African American and 1/3 Hispanic), in collaboration with Southern California dialysis clinics. Nutritional status, dietary intake, psychosocial status, quality of life, clinical events, and survival will be longitudinally assessed. Genetic factors such as APOL1 risk alleles will also be examined, and biospecimens for future ancillary studies will be stored. In a substudy of 360 subjects, additional tests of body composition and dietary intake will be performed. Race/ethnicity specific risk-stratification scores will be developed and validated in a national retrospective cohort of over 150,000 HD patients. The support of the K24 award for this prospective study will allow PI to achieve the following goals: (1) Continue to expand his productive activities and capabilities as a mentor and facilitator for early-career investigators in renal nutrition and CKD disparities by leveraging his networking relationships across several campuses and centers including the University of California system and its Departments of Medicine and Pediatrics, Kaiser Permanente of Southern Calif., UCLA Public Health, and LA and Orange County Health Departments; (2) continue to expand his persistent efforts in increasing the participation of minority populations in CKD research studies across Southern California; and (3) continue his cultivation of an innovative area of CKD disparities and nutrition research through promising early career investigators and the ongoing support of collaborators in Southern California. The data and hypotheses generated during this 5-year cohort study will be utilized to promote additional patient-oriented studies by mentees under Dr. Kalantar to improve patient outcomes.