This is an application for a K23 award for Dr. Carmen A. Peralta, who proposes a novel, multi-disciplinary approach to understanding racial/ethnic disparities in kidney function decline. This award will allow Dr. Peralta the resources and protected time to achieve the following career development goals: (1) to become an independent, translational clinical researcher in the field of racial/ethnic disparities in kidney disease;(2) to become an expert in the application of genetic epidemiology methods to study these differences;and (3) to utilize sociodemographic measurements to improve understanding of the complex mechanisms involved in these disparities. To achieve these goals, Dr. Peralta has assembled a mentoring team comprised of her sponsor and primary mentor, Dr. Michael Shlipak (an expert in the field of cardiovascular complications of early kidney dysfunction), and two co-mentors: Dr. Neil Risch (a genetic epidemiologist) and Dr. Paula Braveman (an expert in social determinants of health). The epidemic of kidney disease currently affects 13% of U.S. adults, and the progression to end stage renal disease (ESRD) affects minorities disparately. African-Americans and Hispanics are the fastest growing groups in the ESRD population. Despite well-documented disparities in progression of advanced kidney disease to ESRD, no studies have evaluated the incidence of chronic kidney disease (CKD) or early kidney function decline in the US across racial/ethnic groups. It is unknown whether certain racial/ethnic groups have an increased genetic predisposition due to a common genetic ancestry or whether social or environ- mental factors explain observed differences. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), Dr. Peralta will compare rates of kidney function decline and incident CKD across four major racial groups and test possible genetic and sociodemographic mechanisms to explain these differences.
Three specific aims are proposed:
Aim 1 : To compare rates of kidney function decline and incident chronic kidney disease across four major racial/ethnic groups (Caucasians, African-Americans, Hispanics, and Chinese- Americans) using creatinine and cystatin C based measures;
Aim 2 : To evaluate whether genetic ancestry is an independent predictor of kidney function decline and incident chronic kidney disease within racial groups and to explore gene-environment interactions in kidney function decline and incident kidney;
and Aim 3 : To evaluate the association of individual and neighborhood-level socioeconomic characteristics with kidney function decline and incident kidney disease across racial groups. Relevance: A better understanding of the mechanisms involved in racial/ethnic disparities in kidney function decline at earlier stages of kidney dysfunction could lead to important interventions and prevention strategies in halting this costly epidemic.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZDK1-GRB-7 (O1))
Program Officer
Rankin, Tracy L
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Malkina, A; Scherzer, R; Shlipak, M G et al. (2015) The association of adiposity with kidney function decline among HIV-infected adults: findings from the Fat Redistribution and Metabolic Changes in HIV Infection (FRAM) study. HIV Med 16:184-90
Park, Meyeon; Shlipak, Michael G; Vittinghoff, Eric et al. (2015) Associations of kidney injury markers with subclinical cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Clin Nephrol 84:358-63
Peralta, Ca; Scherzer, R; Grunfeld, C et al. (2014) Urinary biomarkers of kidney injury are associated with all-cause mortality in the Women's Interagency HIV Study (WIHS). HIV Med 15:291-300
Park, Meyeon; Vittinghoff, Eric; Ganz, Peter et al. (2014) Role of soluble endothelial cell-selective adhesion molecule biomarker in albuminuria and kidney function changes in patients with coronary artery disease: the Heart and Soul Study. Arterioscler Thromb Vasc Biol 34:231-6
O'Seaghdha, Conall M; Tin, Adrienne; Yang, Qiong et al. (2014) Association of a cystatin C gene variant with cystatin C levels, CKD, and risk of incident cardiovascular disease and mortality. Am J Kidney Dis 63:16-22
Peralta, Carmen A; Vittinghoff, Eric; Bansal, Nisha et al. (2013) Trajectories of kidney function decline in young black and white adults with preserved GFR: results from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Kidney Dis 62:261-6
Shlipak, Michael G; Mattes, Monica D; Peralta, Carmen A (2013) Update on cystatin C: incorporation into clinical practice. Am J Kidney Dis 62:595-603
Peralta, Carmen A; Lee, Anne; Odden, Michelle C et al. (2013) Association between chronic kidney disease detected using creatinine and cystatin C and death and cardiovascular events in elderly Mexican Americans: the Sacramento Area Latino Study on Aging. J Am Geriatr Soc 61:90-5
Malkina, Anna; Katz, Ronit; Shlipak, Michael G et al. (2013) Association of Obesity and Kidney Function Decline among Non-Diabetic Adults with eGFR > 60 ml/min/1.73m2: Results from the Multi-Ethnic Study of Atherosclerosis (MESA). Open J Endocr Metab Dis 3:103-112
Peralta, Carmen A; Katz, Ronit; Bonventre, Joseph V et al. (2012) Associations of urinary levels of kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) with kidney function decline in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 60:904-11

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