Geographic and Environmental Health Equity in Kidney Precision Medicine

急性和慢性肾脏疾病(CKD)往往是相互关联的，而且彼此之间都有易感性。两者都有 是常见且昂贵的，但生物标记物和治疗方法是不完整的。肾脏精准医学项目 (KPMP)通过获取肾脏活检的研究方案来解决这一问题 生物分子讯问。此应用程序响应RFA-DK-20-026，建议添加 北卡罗来纳州大学(UNC)和亚利桑那州大学(UA)作为资源丰富的招聘网站 与农村、黑人、拉丁裔和土著人口以及著名的卫生公平和 环境健康研究。纳入地理上不同的人口对KPMP至关重要，因为 以社区环境和环境污染物为代表的健康的社会经济决定因素 解释了慢性肾脏病患病率的大部分地理变异性。 ▪目标1：坚持最高的安全和道德标准，同时成功招聘和 留住来自不同地理、种族和民族人群的KPMP参与者 Aki和/或CKD。我们邀请了生物伦理和健康公平方面的专家，以告知和指导我们的 采取各种方法，克服招聘和留住方面的障碍。为我们的KPMP提供最高安全性 参与者，我们已经与介入放射科合作，进行所有研究性肾脏活检。 ▪目标2：与KPMP的调查人员充分接触和合作，以最大限度地提高效率， 生产力和发现力，目标是减少CKD和AKI造成的人员和经济损失。 我们将坚持现有的KPMP协议，积极参加委员会和写作小组，并 提供创造性的策略来排除障碍并优化KPMP中的工作流程。 ▪目标3：通过包含完全不同的 目前尚未收集的人口和详细环境暴露数据的获取。 慢性KDS的患病率和严重程度存在地理异质性。使用新工具，我们的网站将 提供有关CKD和AKI环境暴露的新信息，这将扩大 解释KPMP的调查结果。 总之，我们的应用程序建议通过人口统计和地理位置进一步加强KPMP 多样化，使用工具评估社区环境并确定环境风险敞口以扩大规模 这些领域的研究机会对AKI和CKDS的发病机制至关重要。

Acute and chronic kidney diseases (CKDs) are often interrelated, and each can predispose to the other. Both are common and costly yet biomarkers and treatments are incomplete. The Kidney Precision Medicine Project (KPMP) addresses this problem via acquisition of research protocol kidney biopsies for pathologic and biomolecular interrogation. This application responds to RFA-DK-20-026, proposing addition of the Universities of North Carolina (UNC) and Arizona (UA) as highly resourced recruitment sites enriched with rural, Black, LatinX and indigenous populations and with renowned centers in health equity and environmental health research. Inclusion of geographically diverse populations is critical to KPMP, as socioeconomic determinants of health represented by neighborhood context and environmental pollutants explain much of the geographic variability of CKD prevalence. ▪ AIM 1: To adhere to the highest safety and ethical standards, while successfully recruiting and retaining KPMP participants from geographically, racially, and ethnically diverse populations with AKI and/or CKDs. We have included experts in bioethics and health equity to inform and guide our approaches and overcome barriers to recruitment and retention. To provide the highest safety for our KPMP participants, we have partnered with interventional radiology to perform all research kidney biopsies. ▪ AIM 2: To fully engage and collaborate with investigators of the KPMP to maximize its efficiency, productivity, and discovery with the goal of reducing the human and economic toll of CKDs and AKI. We will adhere to existing protocols of KPMP, actively participate in committees and writing groups, and provide creative strategies to troubleshoot barriers and optimize workflow within KPMP. ▪ AIM 3: To enhance the breadth of KPMP scientific productivity through inclusion of fully diverse populations and acquisition of detailed environmental exposure data that are currently not captured. There is geographic heterogeneity in the prevalence and severity of CKDs. Using new tools, our site will provide new information about environmental exposures for CKDs and AKI that will broaden the interpretation of KPMP findings. In summary, our application proposes to further strengthen KPMP through demographic and geographic diversification using tools to assess neighborhood context and identify environmental exposures to expand research opportunities in these fields critical to the pathogenesis of AKI and CKDs.