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.

Public Health Relevance

Examining racial and ethnic disparities in chronic kidney disease (CKD) and their relationship to nutritional status, diet and outcomes in dialysis patients may lead to developing more effective strategies to improve outcomes in dialysis population, other 20 million Americans with CKD, and another 30 to 40 million people who suffer from chronic disease states and wasting disorders including chronic heart failure, chronic lung or liver diseases, terminal malignancy, AIDS, advanced age, and other conditions with cachexia. Training and mentoring early-career investigators in CKD disparities and kidney disease nutrition will enhance these important plans.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
7K24DK091419-03
Application #
8531397
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
Project Start
2011-06-01
Project End
2016-05-31
Budget Start
2012-08-01
Budget End
2013-05-31
Support Year
3
Fiscal Year
2012
Total Cost
$150,534
Indirect Cost
$11,151
Name
University of California Irvine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
046705849
City
Irvine
State
CA
Country
United States
Zip Code
92697
Rhee, Connie M; Kovesdy, Csaba P; Ravel, Vanessa A et al. (2017) Association of Glycemic Status During Progression of Chronic Kidney Disease With Early Dialysis Mortality in Patients With Diabetes. Diabetes Care 40:1050-1057
Rhee, Connie M; Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar (2017) Risks of Metformin in Type 2 Diabetes and Chronic Kidney Disease: Lessons Learned from Taiwanese Data. Nephron 135:147-153
Obi, Yoshitsugu; Chou, Jason; Kalantar-Zadeh, Kamyar (2017) Introduction to the Critical Balance - Residual Kidney Function and Incremental Transition to Dialysis. Semin Dial 30:232-234
Ghahremani-Ghajar, Mehrdad; Rojas-Bautista, Vanessa; Lau, Wei-Ling et al. (2017) Incremental Hemodialysis: The University of California Irvine Experience. Semin Dial 30:262-269
Wang, Jialin; Streja, Elani; Soohoo, Melissa et al. (2017) Concurrence of Serum Creatinine and Albumin With Lower Risk for Death in Twice-Weekly Hemodialysis Patients. J Ren Nutr 27:26-36
Laster, Marciana; Soohoo, Melissa; Hall, Clinton et al. (2017) Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients. Pediatr Nephrol 32:685-695
St-Jules, David E; Jagannathan, Ram; Gutekunst, Lisa et al. (2017) Examining the Proportion of Dietary Phosphorus From Plants, Animals, and Food Additives Excreted in Urine. J Ren Nutr 27:78-83
Kalantar-Zadeh, Kamyar (2017) History of Erythropoiesis-Stimulating Agents, the Development of Biosimilars, and the Future of Anemia Treatment in Nephrology. Am J Nephrol 45:235-247
Kalantar-Zadeh, Kamyar; Rhee, Connie M; Chou, Jason et al. (2017) The Obesity Paradox in Kidney Disease: How to Reconcile it with Obesity Management. Kidney Int Rep 2:271-281
Wang, Mengjing; Obi, Yoshitsugu; Streja, Elani et al. (2017) Association of Parameters of Mineral Bone Disorder with Mortality in Patients on Hemodialysis according to Level of Residual Kidney Function. Clin J Am Soc Nephrol 12:1118-1127

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