Racial disparities in chronic kidney disease (CKD) are most profound among persons of low socioeconomic status (SES), and dietary factors (limited availability of healthy foods and unhealthy dietary patterns) likely underlie much of this disparit. Low SES African Americans (AAs) are more likely to experience food insecurity (the inability to afford nutritionally adequate and safe foods) and live in food deserts (areas where low-income residents do not have access to healthy food and fast food restaurants predominate) which likely contributes to racial differences in dietary patterns. Little is known regarding the potentil effectiveness of dietary interventions among low SES AAs at high risk for CKD incidence or progression. Studies quantifying the association between poor diet and disparities in CKD incidence and progression among low SES AAs and identifying effective strategies to improve dietary habits in this population are critically needed, and could lead to reduced racial disparitis in CKD. The overall objectives of this proposal are to 1) determine the contribution of racial differences in dietary patterns to racial disparities in progression to end stage renal disease (ESRD) among low SES individuals in a national population-based study; 2) examine the impact of availability of healthy foods on the effectiveness of a patient, family and community level intervention among low SES AAs with uncontrolled hypertension by using established measures and developing a novel measure of healthy food availability within AAs' homes; 3) identify perceived barriers to healthy dietary patterns and identify potential interventional strategies deemed acceptable among low SES AAs at very high risk for CKD using qualitative methodology; and 4) develop and pilot-test a tailored dietary intervention for low SES AAs at very high risk for CKD by employing the principles of community-based participatory research. The candidate for this K23 Mentored Career Development Award, Dr. Deidra Crews, is an Assistant Professor of Medicine in the Division of Nephrology at Johns Hopkins University and an Associate Faculty Member at the Welch Center for Prevention, Epidemiology and Clinical Research. Her long term goal is to improve health outcomes among vulnerable populations through her work as a clinical investigator. The overarching goal of this application is to establish her successful and independent career studying mechanisms to narrow racial disparities in CKD. Under the guidance of exceptional mentors and advisors, Dr. Crews will extend her prior training and work in clinical epidemiology and health disparities research through further didactic training in nutrition, clinical trials and community-based participatory research, and through the performance of novel, complementary studies. She will conduct this work in the rich training environment of the Welch Center, the Johns Hopkins Bloomberg School of Public Health, and the Hopkins Center to Eliminate Cardiovascular Health Disparities. Dr. Crews' proposed work will not only assure her successful transition to an R01-funded independent investigator, but will also contribute substantially to what is known about racial and socioeconomic disparities in CKD.
African Americans are disproportionately affected by chronic kidney disease in the United States, and this disparity is particularly apparent among socioeconomically disadvantaged African Americans. Limited availability of healthy foods and unhealthy dietary patterns likely contribute to this disparity, and represent modifiable targets fo the prevention of chronic kidney disease in this population.
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