Despite the dramatic growth of the Hispanic population with end stage renal disease in the U.S., relatively little is known about earlier stage of chronic kidney disease (CKD) in Hispanics. The Hispanic Chronic Renal Insufficiency Cohort (CRIC) Study is based at the University of Illinois at Chicago and is an ancillary study to the NIDDK-sponsored multi-center CRIC Study. During the first two funding periods, the study assembled a sizable cohort of Hispanics with moderate to severe CKD (baseline eGFR ~40 ml/min/1.73m2) and addressed critical questions. One key finding was that compared to non-Hispanics whites, Hispanics with CKD are burdened by lower socioeconomic status, poorer blood pressure control, higher depressive symptoms, and lower health-related quality of life (HRQOL). We also found that Hispanics with moderate to severe CKD are at higher risk for CKD progression compared to non-Hispanic whites and that this increased risk is not entirely explained by differences in sociodemographic or clinical factors. As a result of our findings, the scientific scope of this competitive renewal has been broadened to address knowledge gaps in the following areas: 1) the epidemiology of mild CKD, 2) the influence of CKD progression on patient-centered outcomes, and 3) the impact of sociocultural/psychosocial factors on outcomes. First, because individuals with mild CKD comprise a much larger proportion of the CKD population, improving our understanding of modifiable risk factors in mild CKD may have substantial public health implications. Recognizing the need to understand mild CKD, the parent CRIC Study recently recruited 1500 additional individuals with eGFR 45-70 ml/min/1.73m2. However, only 4% of these participants are Hispanic. Second, there is growing recognition of the need to study outcomes defined by patients as important. Our finding of low HRQOL in Hispanics reinforces the need to study the influence of CKD progression on HRQOL and other patient-centered outcomes. Third, accumulating evidence suggests that sociocultural (e.g., acculturation) and psychosocial (e.g., stress, social support, depression) factors influence health outcomes in Hispanics in the general population but these factors have not been studied in the context of CKD. This application seeks to continue follow-up of the existing Hispanic CRIC cohort and enrich it with recruitment of 125 Hispanics with mild CKD (eGFR 45-70 ml/min/1.73m2) to accomplish the following Aims: 1) Evaluate the association of Hispanic ethnicity with risk of CKD progression and cardiovascular events in adults with mild CKD; 2) Examine the relationship of CKD progression with patient-centered outcomes (e.g., HRQOL, physical function, pain) across the spectrum of CKD severity, among Hispanics and across racial/ethnic groups; and 3) Investigate the association of sociocultural and psychosocial factors with CKD progression among Hispanics across the spectrum of CKD severity. The renewal of Hispanic CRIC and its continued close link to the parent CRIC Study provides an unprecedented opportunity to efficiently address a broad range of critical questions regarding the epidemiology of CKD in Hispanics.
During the first two funding periods, the Hispanic Chronic Renal Insufficiency Cohort (CRIC) Study has provided important insights about the burden of moderate to severe chronic kidney disease (CKD) in Hispanics and its impact on outcomes. The proposed renewal expands the scientific scope of the study by focusing on mild CKD and conducting a rigorous evaluation of sociocultural/psychosocial factors and patient-centered outcomes which are relevant to the Hispanic CKD population. Knowledge gained from this study has the potential of contributing to the development of more effective ways to treat Hispanics with CKD.
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