MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKD

项目摘要 这个职业生涯中期的调查员奖续期的目的是，“营养不良、饮食和种族” 《慢性肾脏病的差异(MADRAD)》，作者：Kamyar Kalantar-Zadeh，医学博士，公共卫生硕士，博士，儿科学医学教授 加州大学欧文医学院和加州大学洛杉矶分校公共卫生学院的公共卫生 为他提供大量有保护的时间来继续和扩大他正在进行的以患者为中心的研究 更加专注于指导加州大学的几名早期调查人员 退伍军人事务部在南加州的附属校园。这些中心为服务不足的人提供护理， 患有慢性肾脏病并需要透析才能生存的贫困人口和少数民族。在美国， 非洲裔美国人和西班牙裔美国人患终末期肾病(ESRD)的比例要高得多 (分别是非西班牙裔白人的3.5倍和1.5倍)。虽然ESRD的总体5年存活率 患者不到40%，死亡风险在营养不良患者中最高，少数族裔 透析患者的死亡率较低。发现CKD种族生存差异的根源和 营养状况和饮食因素对这些差异的贡献可能有重大的临床和公众 对健康的影响。 PI假设这些差异是由于与以下因素相关的不同病理生理机制 不同种族/民族的营养状况和饮食摄入量。与以下内容相关的几个可选假设 基因多态、骨骼和矿物质疾病、精神健康和 心理社会因素和透析治疗的特点也将被检查。PI提议为期5年的 1500例血液透析动态队列中重复措施的前瞻性患者研究 (HD)患者(1/3非裔美国人和1/3西班牙裔)，与南加州透析诊所合作。 营养状况、饮食摄入量、心理社会状况、生活质量、临床事件和存活率 纵向评估。还将检查遗传因素，如APOL1风险等位基因，以及生物链霉菌 以备将来的辅助研究之用。在一项对360名受试者的子研究中，对身体成分的额外测试 并进行饮食摄取。将制定种族/民族特定风险分层评分，并 在超过150,000名HD患者的全国回顾队列中得到验证。 K24奖对这项前瞻性研究的支持将使PI能够实现以下目标：(1) 作为早期职业生涯的指导者和促进者，继续扩展他的生产性活动和能力 通过利用他在几个领域的网络关系，研究肾脏营养和慢性肾脏病差异 包括加州大学系统及其医学系和 加州大学洛杉矶分校公共卫生分校，以及洛杉矶和奥兰治县卫生分校 部门；(2)继续扩大他在增加少数群体参与方面的不懈努力 在整个南加州的CKD研究中；以及(3)继续他在 CKD差异和营养研究，通过有前途的早期职业调查人员和持续支持 南加州的合作者。在这项为期5年的队列研究中产生的数据和假设将是 在Kalantar博士的指导下，用于促进更多以患者为中心的研究，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.