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

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.