Malnutrition, Diet and Racial Disparities in CKD

描述（由申请人提供）：加州大学洛杉矶分校医学和公共卫生学院医学、儿科和流行病学副教授Kamyar Kalantar-Zadeh博士颁发的“慢性肾病中的营养不良、饮食和种族差异”中期职业研究者奖的目的是：是为他提供重要的保护时间，以继续和扩大他正在进行的以患者为导向的研究，重点是指导加州大学洛杉矶分校相关校区的早期职业研究者，包括加州大学洛杉矶分校海港分校和查尔斯-德鲁大学。这些中心为缺医少药的贫困人群和少数民族患者提供护理，这些患者患有慢性肾病，需要透析才能生存。在美国透析患者中，非裔美国人和西班牙裔美国人的比例分别是非西班牙裔白人的3.6倍和1.5倍。然而，透析患者的5年生存率<35%，营养不良患者的死亡率最高，少数民族患者的透析死亡率较低。发现CKD种族生存差异的根源及其与营养状况和饮食障碍的联系可能具有重大的临床和公共卫生意义。PI假设这些差异是由于不同种族的营养状况和饮食摄入相关的不同病理生理机制造成的；而与骨骼和矿物质疾病以及社会心理和应对状态相关的两种替代假设也将被检查。PI与南加州DaVita透析诊所合作，提出了一项为期5年的以患者为导向的前瞻性研究，在1050名血液透析（HD）患者（1/3非洲裔美国人和1/3西班牙裔美国人）的动态队列中进行重复测量。将对营养状况、饮食摄入、社会心理状况和生活质量进行纵向评估。临床事件和生存将被跟踪，正在进行的和未来的辅助研究的标本将被保存。在一项包含360名受试者的子研究中，将在GCRC进行额外的身体成分和饮食摄入量测试。种族/民族特定风险分层评分将在超过100,000名HD患者的全国回顾性队列中开发和验证。这个K24奖和拟议的队列研究将使PI能够实现以下目标：(1)通过继续与加州大学洛杉矶分校系统内多个校区、学校和部门（包括系）的教师保持联系，继续并扩大他作为CKD营养和差异领域新研究人员培训的导师和促进者的生产活动和能力。查尔斯-德鲁大学医学和儿科，以及加州大学洛杉矶分校公共卫生。(2)继续并扩大他的可信努力，增加南加州CKD少数民族人群参与研究的可能性；(3)继续发展相对较新的CKD差异和营养研究领域，特别是通过继续支持南加州和全国范围内的DaVita临床研究，通过检查南部透析患者和全国透析队列。在这项为期5年的队列研究中收集的数据和产生的假设将用于支持早期职业研究者和Kalantar博士的学员进行额外的临床研究，以改善患者护理。

DESCRIPTION (provided by applicant): The purpose of this Mid-Career Investigator Award in "Malnutrition, Diet and Racial Disparities in CKD" by Kamyar Kalantar-Zadeh, MD, MPH, PhD, Associate Professor-in-Residence of Medicine, Pediatrics and Epidemiology at UCLA Schools of Medicine & Public Health, is to provide him with significant protected time to continue and expand his ongoing patient-oriented research with heightened focus on mentoring early-career investigators in several UCLA related campuses including Harbor-UCLA and Charles-Drew University. These centers provide care to underserved and indigent populations and minorities who suffer from CKD and who require dialysis to survive. African Americans and Hispanics are vastly overrepresented by 3.6 and 1.5 times greater than non-Hispanic Whites, respectively, among US dialysis patients. Whereas the 5-year survival of dialysis patients is <35%, with the highest mortality among malnourished patients, minorities exhibit lower dialysis mortality. Discovering the roots of CKD racial survival disparities and their link to nutritional status and dietary barriers can have major clinical and public health implications. PI hypothesizes that these disparities are due to distinct pathophysiologic mechanisms related to nutritional status and dietary intake across race; whereas 2 alternative hypotheses related to bone-and-mineral disorders and psychosocial and coping status will also be examined. PI proposes a 5-year patient-oriented, prospective study with repeated measures in a dynamic cohort of 1,050 hemodialysis (HD) patients (1/3 African Americans & 1/3 Hispanics), in collaboration with Southern California DaVita dialysis clinics. Nutritional status, dietary intake, psychosocial status & quality of life will be assessed longitudinally. Clinical events and survival will be followed, and specimens for ongoing and future ancillary studies will be stored. In a substudy of 360 subjects additional tests of body composition and dietary intake will be performed at GCRC. Race/ethnicity specific risk-stratification scores will be develop- ed and validated in a national retrospective cohort of over 100,000 HD patients. This K24 award with proposed cohort study will allow PI to achieve the following goals: (1) Continue and expand his productive activities and capabilities as a mentor and facilitator of training of new investigators in the fields of CKD nutrition & disparities by continuing his liaison with faculty across several campuses, schools and departments within UCLA system including Depts. of Medicine and Pediatrics, Charles-Drew Univ., and UCLA Public Health. (2) Continue and expand his credible efforts in increasing the availability of research participation to minority populations with CKD in Southern California; and (3) Continue to develop a relatively new area of CKD disparity and nutrition research specifically through continued support of the DaVita Clinical Research both in Southern California and across the nation by examining the cohort of Southern dialysis patients and national dialysis cohorts. The data collected and hypotheses generated throughout this 5-year cohort study will be utilized to power additional clinical studies by early career investigators and mentees under Dr. Kalantar to improve on patient care. PUBLIC HEALTH RELEVANCE: Examining racial and ethnic disparities in chronic kidney disease (CKD) and their relationship to nutritional status, diet and outcomes in dialysis patients may lead to developing more effective strategies to improve outcomes in dialysis population, other 20 million Americans with CKD, and another 30 to 40 million people who suffer from chronic disease states and wasting disorders including chronic heart failure, chronic lung or liver diseases, terminal malignancy, AIDS, advanced age, and other conditions with cachexia. Training and mentoring early-career investigators in CKD disparities and kidney disease nutrition will enhance these important plans.