By Mark Rudi

Native Health

UNM researchers win $3.5 million grant to study kidney disease in Southwestern tribes

Thirty-five million adults in the United States are affected by chronic kidney disease (CKD), including 17 percent of Native Americans in the Southwest.

While the number of Native Americans who are developing kidney disease and requiring dialysis has decreased in the past few years, the rate is still higher than in other races.

Vallabh "Raj" Shah, PhD, Distinguished and Regents' Professor in The University of New Mexico's Departments of Biochemistry & Molecular Biology and Internal Medicine, and Mark Unruh, MD, chair of Internal Medicine, will study risk factors for chronic kidney disease among Native Americans in the southwestern U.S. to determine whether any progress is being made.

Shah - who has worked with Native Americans for more than 25 years - and Unruh formed a consortium of investigators with extensive experience in studying chronic diseases, including diabetes, cardiovascular and kidney disease.

The National Institutes of Health (NIH) recently announced a five-year $3.5 million grant to fund the consortium in hopes of improving the understanding of potential risk factors for CKD and cardiovascular disease progression, as well as the impact of the disease among Native Americans.

Shah and Unruh are partnering with the tribal leaders at Zuni Pueblo, First Nations Community Healthsource in Albuquerque, Dialysis Clinics Inc., and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and its Phoenix Epidemiology and Clinical Research Branch on the project.

"Both Raj and I are interested in this issue of chronic kidney disease in the Native American communities because of what we see in the communities," Unruh said. "There has been some improvement in the outcomes of Native Americans, as it relates to development of end-stage renal disease, and that's been shown at the national level. What we feel on the ground is a little bit different. We'll be at a dialysis unit in Acoma, Grants or Taos and you'll have multiple generations who are tribal members who are on dialysis at this same unit.

"For me, while maybe nationally we are doing a little bit better, it doesn't feel so great on the ground. It is really hard on these communities that have limited resources to have to support a large number of people with one of more expensive medical therapies that we have available."

There is a huge burden of chronic kidney disease in Native American communities, even with the progress they have made, Unruh said.

The study will look into questions, including whether there a different rate of progression for the disease among Native Americans compared to other races and ethnicities, and whether Native Americans have a different burden of heart disease.

There have not been many studies on CKD in Native Americans. In 2001, the NIDDK and NIH established a Chronic Renal Insufficiency Cohort to investigate the history and progression of CKD and cardiovascular disease among individuals of European, African and Hispanic descent at 12 U.S. universities.

"This consortium was created to address that issue about the parameters of progression for kidney disease and cardiovascular disease in these people who have kidney disease," Shah said.

However, only 0.5 percent of participants in that study were Native Americans, in part because those 12 universities were not located near Native American communities and Native Americans were not encouraged to take part, Shah said.

For this study, Shah and Unruh both have support from local and national stakeholders and from the communities in which the study will take place.

"For us, we are grateful for all the support that we have," Unruh said. "It's a big study, and we have big expectations. We have a great team here in New Mexico to help us do this study."