(taken from the application) We are in the midst of an epidemic of end stage renal disease (ESRD). Treated ESRD has increased exponentially at an annual rate of 8% since 1973 when the U.S. ESRD treatment registry was initiated. Although it preserves life, treated ESRD is associated with poor quality of life, considerable morbidity, and high mortality. The leading cause of death in treated ESRD patients is cardiovascular disease. The Principal Investigator is a leader in the epidemiology and prevention of renal disease who has an outstanding track record in patient-oriented research and mentorship. He has assembled and mentored a team of superb young investigators who are seeking to understand better the reasons for the increased risk of cardiovascular disease in patients with treated ESRD and less severe forms of renal disease. Mentorship is accomplished through a rigorous program of training in epidemiologic methods and intensive involvement in ongoing, federally-funded research projects. Tuition costs are covered by NIH sponsored training grants from NIDDK and NHLBI. The current proposal requests funds to increase the Principal Investigator's ability to mentor trainees and junior faculty by decreasing his substantial administrative commitment. The research projects described in this proposal are built on the foundation of the CHOICE Cohort Study, a national prospective study of over 1,000 incident cases of ESRD. A DNA and serum bank has been established at a central laboratory. Current research project conducted by trainees who will be mentored by the Principal Investigator as part of the current proposal include: 1. The role of emerging risk factors (Lpa, homocysteine, B vitamin, fibrinogen levels) in risk of CVD ESRD patients; 2. Identification of genes that increase risk of progression to ESRD; 3. Risk factors for vascular access failure. This information will lay the groundwork to prevent CVD in ESRD patients by providing the information needed for clinical trials. The Principal Investigator has a long history of successful mentoring in renal disease research. The proposed award will allow him to continue training the next generation of renal disease epidemiologists.
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