Malnutrition, Diet and Racial Disparities in CKD

描述(由申请人提供)：由加州大学洛杉矶分校医学院和公共卫生学院医学、儿科和流行病学副教授Kamyar Kalantar-Zadeh，医学博士，公共卫生硕士，博士Kamyar Kalantar-Zadeh颁发的“CKD中的营养不良，饮食和种族差异”职业中期研究人员奖的目的是为他提供大量的保护时间来继续和扩大他正在进行的以患者为导向的研究，重点是指导几个与加州大学洛杉矶分校相关的校园的职业早期调查人员，包括港湾-加州大学和查尔斯-德鲁大学。这些中心为服务不足和贫困的人群以及患有慢性肾脏病并需要透析才能生存的少数民族提供护理。在美国透析患者中，非洲裔美国人和西班牙裔美国人的比例远远高于非西班牙裔白人，分别高出3.6倍和1.5倍。尽管透析患者的5年存活率为35%，在营养不良患者中死亡率最高，但少数民族的透析死亡率较低。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会对临床和公共卫生产生重大影响。PI假设这些差异是由于与不同种族的营养状况和饮食摄入量有关的不同病理生理机制；而与骨骼和矿物质障碍以及心理社会和应对状况有关的两个替代假设也将被审查。PI建议与南加州DaVita透析诊所合作，在1050名血液透析(HD)患者(1/3非裔美国人和1/3西班牙裔美国人)的动态队列中进行一项为期5年的、以患者为导向的前瞻性研究。将对营养状况、饮食摄入量、心理社会状况和生活质量进行纵向评估。将跟踪临床事件和生存情况，并将为正在进行的和未来的辅助研究保存标本。在一项对360名受试者进行的子研究中，GCRC将进行身体成分和饮食摄入量的额外测试。种族/民族特定的风险分层评分将在全国100,000多名HD患者的回顾队列中进行开发和验证。这项K24奖项和建议的队列研究将使Pi能够实现以下目标：(1)继续并扩大他作为CKD营养和差异领域新调查人员培训导师和促进者的生产性活动和能力，通过继续他与几个校园、学校和加州大学洛杉矶分校系统内的系(包括部门)的教职员工的联系。医学和儿科，查尔斯-德鲁大学和加州大学洛杉矶分校公共卫生。(2)继续并扩大他可信的努力，以增加南加州慢性肾脏病少数群体参与研究的机会；以及(3)继续开发CKD差异和营养研究的相对较新的领域，特别是通过继续支持南加州和全国各地的DaVita临床研究，检查南加州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被用来支持早期职业研究人员和Kalantar博士指导下的学员进行更多的临床研究，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.