Pilot 2
Andrew Smith, MD, PhD
Department of Radiology,
University Mississippi Medical Center
Biography
Andrew D. Smith M.D. Ph.D. is an assistant professor, a genitourinary radiologist and oncologic imager, and the research director in the Department of Radiology at the University of Mississippi Medical Center. His primary interest is in understanding the relationship of renal fat with hypertension and chronic kidney disease (CKD) in African Americans. A resident and employee in the Jackson, MS area, Dr. Smith plans to study this relationship in the African American participants of the Genetics Epidemiology Network of Atherosclerosis (GENOA) study in Jackson, MS. This work has been funded by the Center for Integrative Approaches to Health Disparities (CIAHD). Dr. Smith is also evaluating the relationship of bone density with renal disease and coronary atherosclerotic disease in African American participants in the GENOA study and working with collaborators in the Jackson Heart Study to further understand the relationship of renal fat with hypertension and CKD in African Americans. Dr. Smith is mentored by Dr. Thomas Mosley, an experienced epidemiologist and health disparities researcher, professor in geriatric medicine, co-investigator in the GENOA study, and primary investigator of the Atherosclerosis Risk in Communities (ARIC) study. Dr. Smith is collaborating with Dr. Larry Bielak, an experienced biostatistician at the University of Michigan who is interested in health-disparities research in African Americans, who has previously been a primary investigator for a CIAHD-supported study, and who has prior experience with the GENOA study.
Research Abstract
Associating renal sinus fat (RSF) with hypertension, anti-hypertensive medication burden, and chronic kidney disease in African Americans in the GENOA study
African Americans (AAs) have an increased incidence and prevalence of obesity and hypertension with poorer control and an associated increased number of anti-hypertensive medications compared to non-hispanic white [European] Americans (EAs). The increased anti-hypertensive medication burden imposes an economic and psychosocial burden upon AA individuals. Animal research and recent studies in a predominantly EA cohort have linked fat accumulation in the central aspect of the kidney (the renal sinus) with obesity, hypertension, increased number of anti-hypertensive medications, retroperitoneal fat volume, and chronic kidney disease. It is unclear if renal fat is associated with hypertension control, increased anti-hypertensive medication burden, and decreased renal function in AAs. We propose to build upon the longitudinal Genetic Epidemiology Network of Arteriopathy (GENOA) Study, part of the Family Blood Pressure Program. The GENOA study includes an AA cohort of hypertensive siblings from Jackson, MS that has been followed for approximately 15 years over four visits for target organ damage of the heart, brain, and kidneys. The most recent visit included computed tomography (CT) imaging of the abdomen in 659 individuals. The CT images from this study are suitable for measuring renal fat and kidney volumes. We hypothesize that excessive fat accumulation in the renal sinus has an active role in promoting hypertension and CKD, particularly in AAs. The primary aim of this preliminary inter-institutional collaborative study is to investigate whether increased renal sinus fat is associated with blood pressure control, increased number (burden) of anti-hypertensive medications and/or decreased renal function in African American participants from the GENOA study, before and after adjusting for traditional risk factors for chronic kidney disease. Secondary goals are to develop a young investigator with an interest in cardiovascular/renal disease and health disparities in AAs and to use the preliminary data generated by this proposal to develop a NIH grant application. View Figure 1 Renal Sinus Fat Volume, CT images demonstrating techniques for quantifying renal sinus fat volume
