Malnutrition, Diet and Racial Disparities in Chronic Kidney Disease (CKD)

NCT ID: NCT01415570

Last Updated: 2015-05-21

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 1050 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2011-08-31
• Study Completion Date: 2016-11-30

Brief Summary

In the United States, African Americans are 3.6 time and Hispanics 1.5 times more likely to suffer from chronic kidney disease and need dialysis treatment for life, when compared to the non-Hispanic Whites. Unfortunately many dialysis patients die, so that after 5 years only less than 35% are still alive. Dialysis patients who appear malnourished or who have muscle and fat wasting are even more likely to die. Interestingly, among dialysis patients, minorities (African Americans, Hispanics and Asian Americans) usually survive longer than the non-Hispanic Whites. If the investigators can discover the reasons for these so-called "racial survival disparities" of dialysis patients, the investigators may be able to improve survival for all dialysis patients and maybe even for many other people who suffer from other chronic diseases. During this 5 year study the investigators would like to test if a different nutrition and diet can explain better survival of minority dialysis patients. The investigators will also test if in additional to nutrition there are 2 other reasons for better survival of minority dialysis patients, namely differences in bone and minerals and differences in social and psychological and mental health. The investigators plan to study 450 hemodialysis patients every 6 months in several dialysis clinics in Los Angeles South Bay area. These subjects will include 30% African Americans, 30% Hispanics, 30% non-Hispanic Whites and 10% Asians. Every 6 months the investigators will examine their nutritional conditions, dietary intake, psycho-social conditions and quality of life, and will recruit 75 new subjects to replace those who left our study as a result of kidney transplantation, death or other reasons. Hence, the investigators estimate studying a total of 1,050 hemodialysis patients over 5 years. Clinical events such as hospital admissions and survival will be followed. Blood samples will be obtained every 6 months for measurements of hormones and "biomarkers", and the remainder of the blood will be stored in freezers for future measurements. The investigators plan to design and develop race and ethnicity specific nutritional risk scores and food questionnaires and will test some of these scores in larger national databases of hemodialysis patients. Almost a year after the study starts, the investigators also plan to do additional tests of body composition and dietary intake in a smaller group of these patients at the GCRC.

Detailed Description

I. SPECIFIC AIMS & HYPOTHESES I.1.HYPOTHESES: Despite higher burden of chronic kidney disease (CKD) in minorities, they have greater survival compared to non-Hispanic Whites with CKD. The investigators hypothesize that survival advantages of minority CKD patients (pts) result from biologically plausible mechanisms related to differences in nutritional status & diet (main hypothesis) or differences in bone-&-minerals and/or psychosocial & coping status (2 alternative hypotheses). Differences in these conditions may lead to different degrees of protein-energy wasting, inflammation, oxidative stress, & platelet activation, leading to thrombo-embolic & cardiovascular (CV) events. Discovering the biology of CKD racial survival disparities may lead to improving outcomes in both CKD and others chronic diseases.

During this 5-year study the principal investigator (Dr. Kalantar-Zadeh) will also help a number of early-career investigators to design and develop additional studies including research in minority populations with chronic diseases using data and resources of this study.

Conditions

Chronic Kidney Disease (CKD); End-Stage Renal Disease (ESRD)

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Chronic Hemodialysis Patients

Adult hemodialysis patients

No interventions assigned to this group

Chronic hemodialysis patients

Adult hemodialysis patients

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• Adult (18-85 yrs) patients
• HD > 4 weeks

Exclusion Criteria

• Terminal disease with life expectancy < 6 months

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role: collaborator

Davita Clinical Research

INDUSTRY

Sponsor Role: collaborator

Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Kamyar Kalantar-Zadeh, MD, MPH, PhD

Role: PRINCIPAL_INVESTIGATOR

LABioMed at Harbor-UCLA

Locations

Harold Simmons Center for Kidney Disease Research & Epidemiology

Torrance, California, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Caludia Luna

Role: CONTACT

cluna@labiomed.org

310-222-2346

Jennie Jing, MS

Role: CONTACT

jjing@labiomed.org

310-781-3650

Facility Contacts

Claudia Luna

Role: primary

cluna@labiomed.org

310-222-2346

References

Noori N, Kovesdy CP, Dukkipati R, Feroze U, Molnar MZ, Bross R, Nissenson AR, Kopple JD, Norris KC, Kalantar-Zadeh K. Racial and ethnic differences in mortality of hemodialysis patients: role of dietary and nutritional status and inflammation. Am J Nephrol. 2011;33(2):157-67. doi: 10.1159/000323972. Epub 2011 Feb 4.

Reference Type: BACKGROUND

PMID: 21293117 (View on PubMed)

Feroze U, Noori N, Kovesdy CP, Molnar MZ, Martin DJ, Reina-Patton A, Benner D, Bross R, Norris KC, Kopple JD, Kalantar-Zadeh K. Quality-of-life and mortality in hemodialysis patients: roles of race and nutritional status. Clin J Am Soc Nephrol. 2011 May;6(5):1100-11. doi: 10.2215/CJN.07690910. Epub 2011 Apr 28.

Reference Type: BACKGROUND

PMID: 21527646 (View on PubMed)

Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Noori N, Murali SB, Block T, Norris J, Kopple JD, Block G. Design and development of a dialysis food frequency questionnaire. J Ren Nutr. 2011 May;21(3):257-62. doi: 10.1053/j.jrn.2010.05.013. Epub 2010 Sep 15.

Reference Type: BACKGROUND

PMID: 20833073 (View on PubMed)

Bross R, Noori N, Kovesdy CP, Murali SB, Benner D, Block G, Kopple JD, Kalantar-Zadeh K. Dietary assessment of individuals with chronic kidney disease. Semin Dial. 2010 Jul-Aug;23(4):359-64. doi: 10.1111/j.1525-139X.2010.00743.x. Epub 2010 Jul 29.

Reference Type: BACKGROUND

PMID: 20673254 (View on PubMed)

Bross R, Chandramohan G, Kovesdy CP, Oreopoulos A, Noori N, Golden S, Benner D, Kopple JD, Kalantar-Zadeh K. Comparing body composition assessment tests in long-term hemodialysis patients. Am J Kidney Dis. 2010 May;55(5):885-96. doi: 10.1053/j.ajkd.2009.12.031. Epub 2010 Mar 25.

Reference Type: BACKGROUND

PMID: 20346558 (View on PubMed)

Kalantar-Zadeh K, Kovesdy CP, Derose SF, Horwich TB, Fonarow GC. Racial and survival paradoxes in chronic kidney disease. Nat Clin Pract Nephrol. 2007 Sep;3(9):493-506. doi: 10.1038/ncpneph0570.

Reference Type: BACKGROUND

PMID: 17717562 (View on PubMed)

Kalantar-Zadeh K, Golan E, Shohat T, Streja E, Norris KC, Kopple JD. Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity. Semin Dial. 2010 Nov-Dec;23(6):586-94. doi: 10.1111/j.1525-139X.2010.00795.x.

Reference Type: BACKGROUND

PMID: 21175833 (View on PubMed)

Streja E, Kovesdy CP, Molnar MZ, Norris KC, Greenland S, Nissenson AR, Kopple JD, Kalantar-Zadeh K. Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients. Am J Kidney Dis. 2011 Jun;57(6):883-93. doi: 10.1053/j.ajkd.2010.10.050. Epub 2011 Jan 15.

Reference Type: BACKGROUND

PMID: 21239093 (View on PubMed)

Molnar MZ, Streja E, Kovesdy CP, Budoff MJ, Nissenson AR, Krishnan M, Anker SD, Norris KC, Fonarow GC, Kalantar-Zadeh K. High platelet count as a link between renal cachexia and cardiovascular mortality in end-stage renal disease patients. Am J Clin Nutr. 2011 Sep;94(3):945-54. doi: 10.3945/ajcn.111.014639. Epub 2011 Aug 3.

Reference Type: BACKGROUND

PMID: 21813809 (View on PubMed)

Rhee CM, You AS, Nguyen DV, Brunelli SM, Budoff MJ, Streja E, Nakata T, Kovesdy CP, Brent GA, Kalantar-Zadeh K. Thyroid Status and Mortality in a Prospective Hemodialysis Cohort. J Clin Endocrinol Metab. 2017 May 1;102(5):1568-1577. doi: 10.1210/jc.2016-3616.

Reference Type: DERIVED

PMID: 28324018 (View on PubMed)

Other Identifiers

K24DK091419

Identifier Type: NIH

Identifier Source: secondary_id

View Link

14100

Identifier Type: -

Identifier Source: org_study_id