Malnutrition, Diet and Racial Disparities in CKD

描述（申请人提供）：这项由加州大学洛杉矶分校医学与公共卫生学院医学、儿科和流行病学副教授Kamyar Kalantar-Zadeh博士颁发的“CKD中的营养不良、饮食和种族差异”职业中期研究者奖的目的，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病人为导向的研究，重点是早期指导，职业调查员在几个加州大学洛杉矶分校相关的校园，包括港口，加州大学洛杉矶分校和查尔斯德鲁大学。这些中心为服务不足和贫困人口以及患有CKD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分别是非西班牙裔白人的3.6倍和1.5倍。尽管透析患者的5年存活率低于35%，营养不良患者的死亡率最高，但少数群体的透析死亡率较低。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之间与营养状况和饮食摄入相关的不同病理生理机制所致;而还将检查与骨和矿物质疾病以及心理社会和应对状况相关的2个替代假设。PI提议与南加州DaVita透析诊所合作，在1,050例血液透析（HD）患者（1/3非洲裔美国人和1/3西班牙裔）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，重复测量。将对营养状况、饮食摄入、心理社会状况和生活质量进行纵向评估。将对临床事件和生存期进行随访，并将储存用于正在进行的和未来辅助研究的标本。在一项包含360例受试者的子研究中，将在GCRC进行身体成分和饮食摄入的额外检测。将在超过100，000例HD患者的国家回顾性队列中开发和验证人种/种族特定风险分层评分艾德。这个K24奖项与拟议的队列研究将使PI实现以下目标：（1）继续和扩大他的生产活动和能力，作为CKD营养和差异领域新研究人员的导师和促进者，继续与加州大学洛杉矶分校系统内的几个校区，学校和部门（包括部门）的教师保持联系。查尔斯-德鲁大学医学与儿科系加州大学洛杉矶分校公共卫生部(2)继续并扩大其可信的努力，以增加南加州少数CKD人群参与研究的可用性;和（3）继续开发CKD差异和营养研究的相对新领域，特别是通过继续支持南加州和全国范围内的DaVita临床研究，检查南方透析患者队列和全国透析队列。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Kalantar博士领导下的早期职业研究者和学员进行的额外临床研究，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.