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博士提供指导指导，因为她成为独立的临床医生研究员。 Anand博士在全球卫生环境中对肾脏疾病护理感兴趣，尤其是在低调和中等收入国家的慢性肾脏疾病（CKD）负担不断增长，并制定了管理CKD的创新策略。因此，该提案将研究南亚人的CKD的流行病学，并评估糖尿病患者管理的低成本工具。最近，已确定南亚人以糖尿病和代谢综合征的形式处于胰岛素抵抗的高风险，糖尿病的患病率高四倍，比美国白人高四倍。然而，有限的数据可在最重要的最重要的器官后果之一（即CKD）上获得。该提案使用南亚（Carrs）研究中降低心脏代谢风险的数据，这是一个基于社区的成年人同类，居住在新德里，钦奈和卡拉奇研究CKD的流行和发病率，其假设是胰岛素抵抗将是CKD的主要风险因素，即CKD的主要风险因素，即使是居住在资源量中的CKD。为了评估诸如血糖和血压等危险因素的管理在确定CKD负担方面起作用的程度，该研究将比较居住在美国的南亚人（预期可以更好地管理风险因素）的CKD患病率的CKD患病率。居住在美国的南亚人（Masala）研究和泛亚人群（PAC）研究数据库的南亚人动脉粥样硬化的调解人将创建一个合并的数据集，以执行此分析。此外，该研究将探讨哪些体型（腰围，腰围比或体重指数）和胰岛素抵抗（禁食葡萄糖，血红蛋白A1C或禁食胰岛素水平）的哪些标志物可以预测南亚的新开始CKD。该提案的最终目的是在印度乡村的五个地点进行的一项正在进行的随机控制试验中创建一个子研究。该子培训将评估结构化的教育干预措施 卫生工作者在接受筛查尿液量后激励糖尿病患者寻求护理，这将被用作识别高风险（蛋白尿）患者的工具，以及讨论糖尿病的最终器官后果。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 南亚人中的CKD，并试图通过低成本策略来管理它。通过此建议，Anand博士将通过研究Carrs，Masala和PAC数据库的分析来提高她的流行病学技能。她将通过教学课程和现场项目实施获得卫生服务研究的额外培训。在整个过程中，她将获得全球卫生，肾脏病，卫生政策和生物统计学专家的培训和指导，因为她为生产研究职业奠定了坚实的基础。