Epidemiology and management of chronic kidney disease in South Asians

南亚人慢性肾脏病的流行病学和治疗

• 批准号: 8679738
• 负责人: Shuchi Anand
• 金额: $ 17.89万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8679738
• 关键词: 18 year old; Adherence; Adult; Aftercare; Age-Years; Albuminuria; Americas; Angiotensin-Converting Enzyme Inhibitors; Area; Asia; Asians; Atherosclerosis; Biometry; Blood Glucose; Blood Pressure; Body Size; Body Weight; Body mass index; Caring; Central obesity; Chicago; Chronic Disease; Chronic Kidney Failure; Communication Tools; Communities; Control Groups; Country; Data; Data Set; Databases; Diabetes Mellitus; Diet; Education; Educational Intervention; Effectiveness; Electronic Health Record; Epidemiology; Ethnic group; Fasting; Foundations; Generations; Glycosylated hemoglobin A; Goals; Health; Health Personnel; Health Policy; Health Services Research; High Prevalence; Immigrant; Incidence; Income; India; Insulin; Insulin Resistance; Intervention; Kidney Diseases; Life; Link; Mediator of activation protein; Mentors; Metabolic syndrome; Nephrology; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Organ; Patient Care Team; Patients; Play; Population; Prevalence; Prevalence Study; Process; Proteinuria; Provider; Proxy; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk Factors; Risk Reduction; Role; Rural; San Francisco; Site; South Asian; Staging; Structure; Surveys; Training; Urine; Visceral; Waist-Hip Ratio; Work; adiponectin; alpha-Fetoproteins; base; care seeking; career; cohort; cost; design; epidemiology study; fasting glucose; global health; high risk; innovation; interest; lifestyle intervention; public health relevance; racial and ethnic; screening; skills; surveillance study; tool; waist circumference

DESCRIPTION (provided by applicant): The primary purpose of this proposal is to provide mentored guidance for Dr. Shuchi Anand as she becomes an independent clinician researcher. Dr. Anand is interested in kidney disease care in a global health context, particularly in highlighting the growing burden of chronic kidney disease (CKD) in low- and middle-income countries and in devising innovative strategies to manage CKD. Thus this proposal will study the epidemiology of CKD in South Asians and evaluate low-cost tools for its management in patients with diabetes. South Asians have recently been identified to be at high risk for insulin resistance in the form of diabetes and metabolic syndrome, with a four-fold higher prevalence and two-fold higher incidence of diabetes than U.S. whites. Yet limited data are available on one of the most important end-organ consequences, i.e., CKD. This proposal uses data from the Cardiometabolic Risk Reduction in South Asia (CARRS) study, a community-based cohort of adults living in New Delhi, Chennai, and Karachi to study the prevalence and incidence of CKD, with the hypothesis that insulin resistance will be the primary risk factor for CKD even among South Asians living in a resource-constrained setting. To evaluate the extent to which management of risk factors such as blood glucose and blood pressure plays a role in determining the burden of CKD, the study will compare CKD prevalence in CARRS with CKD prevalence in South Asians living in the U.S. (where risk factors are expected to be better managed). A pooled dataset will be created from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and the Pan Asian Cohort (PAC) Research Database to perform this analysis. In addition the study will explore which markers of body size (waist-circumference, waist-to-hip ratio, or body mass index) and of insulin resistance (fasting glucose, hemoglobin a1c, or fasting insulin levels) best predict new onset CKD among South Asians. The final aim of this proposal is to create a sub-study within an ongoing randomized control trial in five sites in rural India. The sub-study will evaluate a structured education intervention by a lay health worker in motivating patients with diabetes to seek care after undergoing a screening urine dipstick, which will be used as a tool to identify high risk (proteinuric) patients as well a to discuss the end-organ consequences of diabetes. A qualitative survey of patients and providers will also be performed to identify barriers to care. The overall goal is to report on the burden of CKD among South Asians and attempt to manage it with low-cost strategies. With this proposal, Dr. Anand will advance her epidemiology skills by working on analyses from the CARRS, MASALA, and PAC databases. She will obtain additional training in health services research via didactic coursework and on-the-ground project implementation. Throughout the process, she will receive training and guidance from experts in global health, nephrology, health policy, and biostatistics as she builds a strong foundation for a productive research career.

描述（由申请人提供）：本提案的主要目的是为 Shuchi Anand 博士成为一名独立临床研究员提供指导。 Anand 博士对全球健康背景下的肾脏疾病护理感兴趣，特别是强调低收入和中等收入国家慢性肾脏病 (CKD) 日益沉重的负担，并制定管理 CKD 的创新策略。因此，该提案将研究南亚人 CKD 的流行病学，并评估糖尿病患者管理的低成本工具。最近发现，南亚人患糖尿病和代谢综合征等胰岛素抵抗的风险较高，其患病率和发病率是美国白人的四倍和两倍。然而，关于最重要的终末器官后果之一（即 CKD）的可用数据有限。该提案使用了南亚心脏代谢风险降低 (CARRS) 研究的数据，该研究是一项居住在新德里、钦奈和卡拉奇的社区成年人队列研究，旨在研究 CKD 的患病率和发病率，并假设胰岛素抵抗将即使对于生活在资源有限环境中的南亚人来说，这也是 CKD 的主要危险因素。为了评估血糖和血压等危险因素的管理在确定 CKD 负担方面发挥的作用程度，该研究将比较 CARRS 中的 CKD 患病率与居住在美国的南亚人的 CKD 患病率（其中危险因素为预计会得到更好的管理）。居住在美国的南亚人动脉粥样硬化调节因子 (MASALA) 研究和泛亚队列 (PAC) 研究数据库将创建一个汇总数据集来执行此分析。此外，该研究还将探讨哪些身体尺寸标志物（腰围、腰臀比或体重指数）和胰岛素抵抗标志物（空腹血糖、血红蛋白 a1c 或空腹胰岛素水平）最能预测新发 CKD南亚人。该提案的最终目标是在印度农村五个地点正在进行的随机对照试验中创建一项子研究。该子研究将评估由非专业人士进行的结构化教育干预 卫生工作者激励糖尿病患者在接受尿液试纸筛查后寻求护理，尿液试纸将用作识别高风险（蛋白尿）患者以及讨论糖尿病的终末器官后果的工具。还将对患者和提供者进行定性调查，以确定护理障碍。总体目标是报告负担 南亚人患有慢性肾病，并尝试通过低成本策略进行管理。通过这项提案，Anand 博士将通过对 CARRS、MASALA 和 PAC 数据库进行分析来提高她的流行病学技能。她将通过教学课程和实地项目实施获得卫生服务研究方面的额外培训。在整个过程中，她将接受全球健康、肾病学、卫生政策和生物统计学专家的培训和指导，为她富有成效的研究生涯奠定坚实的基础。