End-Stage Kidney Disease in California's Central Valley: Investigating a Hotspot of Kidney Disease

Stanford University, Stanford CA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT California’s Central Valley has one of the highest incidence of end-stage kidney disease in the United States. This region shares climate, topography, and agricultural activity with international regions experiencing epidemics of chronic kidney disease among agricultural workers, termed chronic kidney disease of unknown etiology (CKDu). It remains unclear whether agricultural workers in California are also vulnerable to a disproportionate risk for chronic kidney disease. In her post-doctoral training period, Dr. Marimar Contreras Nieves aims to investigate potential environmental and occupational exposures related to kidney disease in California’s Central Valley by: 1) leveraging existing data on temperature records and incident kidney disease, and 2) leading primary data collection among patients undergoing dialysis in Central Valley. She will use existing data from the United States Renal Data System (USRDS) to obtain zip code tabulation area end-stage kidney disease incidence, and test its association with 5-year antecedent temperature maximums using data from the PRISM Climate group, accounting for geographic distribution of age, sex, race, ethnicity, occupation, income, comorbid medical conditions, and air quality. In addition, Dr. Contreras Nieves proposes a case-control study to recruit a total of 600 patients, with cases being patients with unexplained ESKD, who will be matched by age and sex to controls with known causes of ESKD from dialysis units in pre-identified hotspots of unexplained ESKD. She will administer a questionnaire to ascertain patients’ residence and workplace history, clinical history, agricultural work history, pesticide and groundwater exposure, and healthcare access. Dr. Contreras Nieves’s multidisciplinary team of mentors will include as primary mentor nephrologist Dr. Shuchi Anand, as co-mentors geochemist Dr. Penny Vlahos and biostatistician Dr. Maria Montez-Rath, and as collaborator Dr. Sam Heft-Neal, who will work together to position Dr. Contreras Nieves as an expert in environmental health and community-engaged research in nephrology. In summary, this proposal will provide Dr. Contreras Nieves with the mentorship, training, and research experience to develop a career development award proposal at the intersection of environmental health and kidney disease.