This is an application for a K23 award for Dr. Andy Choi, an instructor in nephrology at the University of California San Francisco and a young patient-oriented researcher in the area of HIV-related kidney disease. This K23 award will provide Dr. Choi with training and mentored research experience in the following areas: (1) recruiting and maintaining a patient cohort;(2) performing physiologic measurements in patients, (3) expertise in GFR measurement, (4) training in translational HIV medicine, (5) statistical methods for comparing measurement techniques and diagnostic tests, and (6) designing and implementing pilot intervention studies. To achieve these training goals, Dr. Choi has assembled a mentoring team comprised of a primary mentor, Dr. Michael Shlipak, Chief of General Internal Medicine at the San Francisco VA Medical Center, who is an epidemiologist in kidney disease and a national expert in the use of cystatin C, and 3 co-mentors: Dr. Carl Grunfeld, an expert in the metabolic complications of HIV-infection and in performing physiologic measurements in human subjects;Dr. Jeffrey Martin, an epidemiologist and codirector of the Study of the Consequences of the Protease Inhibitor Era (SCOPE);and Dr. Peter Bacchetti, an expert in the biostatistical methods for studying longitudinal outcomes among HIV-infected patients. Cystatin C is a novel measure of kidney function that has been found to be a more sensitive test than creatinine for the diagnosis of kidney disease in several populations. In order to establish which marker of kidney disease is most accurate in the HIV-infected population, we will measure cystatin C, serum creatinine, body composition, and the gold standard of directly measured GFR in a subset of patients enrolled in the SCOPE cohort.
The specific aims of this K23 grant are to compare the performance of creatinine-based estimates of kidney function and cystatin C with directly measured GFR using iothalamate clearance;to reassess previously recognized risk factors of kidney dysfunction using gold standard GFR;and to describe novel risk factors associated with kidney function decline in HIV-infected persons.

Public Health Relevance

Better methods for detecting renal dysfunction will improve our ability to accurately diagnosis and stage kidney disease, to make adjustments to dosing of HAART medications and to monitor for renal toxicity, and to assess promising interventions to detect and treat early stages of kidney disease.

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-D (J1))
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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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Scherzer, Rebecca; Gandhi, Monica; Estrella, Michelle M et al. (2014) A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans. AIDS 28:1289-95
Anand, Shuchi; Johansen, Kirsten L; Grimes, Barbara et al. (2013) Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study. Hemodial Int 17:50-8
Hall, Yoshio N; Choi, Andy I; Xu, Ping et al. (2013) Predictors of end-stage renal disease in the urban poor. J Health Care Poor Underserved 24:1686-700
Anand, Shuchi; Chertow, Glenn M; Johansen, Kirsten L et al. (2013) Vitamin D deficiency and mortality in patients receiving dialysis: the Comprehensive Dialysis Study. J Ren Nutr 23:422-7
Hall, Yoshio N; Choi, Andy I; Himmelfarb, Jonathan et al. (2012) Homelessness and CKD: a cohort study. Clin J Am Soc Nephrol 7:1094-102
Scherzer, Rebecca; Estrella, Michelle; Li, Yongmei et al. (2012) Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS 26:867-75
Jotwani, Vasantha; Li, Yongmei; Grunfeld, Carl et al. (2012) Risk factors for ESRD in HIV-infected individuals: traditional and HIV-related factors. Am J Kidney Dis 59:628-35
Li, Yongmei; Shlipak, Michael G; Grunfeld, Carl et al. (2012) Incidence and risk factors for acute kidney injury in HIV Infection. Am J Nephrol 35:327-34
Choi, Andy I; Vittinghoff, Eric; Deeks, Steven G et al. (2011) Cardiovascular risks associated with abacavir and tenofovir exposure in HIV-infected persons. AIDS 25:1289-98
Anand, Shuchi; Chertow, Glenn M; Johansen, Kirsten L et al. (2011) Association of self-reported physical activity with laboratory markers of nutrition and inflammation: the Comprehensive Dialysis Study. J Ren Nutr 21:429-37

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