Program Director/Principal Investigator (Last, First, Middle): Shah, Vallabh O and Unruh Mark Despite experiencing high levels of kidney disease compared to other ethnic/racial groups in the United States, American Indians (AIs) continue to receive relatively little attention from researchers studying CKD. An example is the current CRIC study, where less than 1% of participants in this flagship study are AIs. Risk factors for diabetic kidney disease, the predominant form of CKD in this population, include the traditional risk factors of hyperglycemia, hypertension, and inheritance, but also other factors such as exposure to various persistent environmental pollutants. The distribution and determinants of CKD among AIs has been understudied, leaving many questions unanswered about the progression of CKD among AIs, as well as the prevalence of cardiovascular disease (CVD) in the setting of CKD among these populations. This is an urgent issue given the public health impact in AI communities and the relative lack of ongoing research. To address this burden of CKD in Native communities we have formed a consortium of investigators with extensive experience in conducting research of chronic diseases including diabetes, cardiovascular and kidney disease in AIs of Southwestern US. Our proposed CRIC ancillary cohort study of 500 AIs (AI-CRIC) will rapidly improve our understanding of both potential risk factors for CKD progression, as well as the scope of this disease among AIs. This proposal leverages the current CRIC study and incorporates the planned activities of the next phase of the study ? ?CRIC 2018? ? by implementing contemporary CRIC protocols for kidney and cardiovascular measurement and outcomes. The overall goal of the proposed prospective cohort study is to precisely assess the extent to which there are higher rates of CKD/CVD progression in AIs than in other racial/ethnic groups based on standardized definitions used throughout CRIC and relate CKD to the levels of potential environmental and occupational exposures unique to AIs residing in the American Southwest. To better understand the natural history of CKD/CVD in this high-risk population, AI-CRIC will implement the CRIC 2018 protocol of ambulatory monitoring of kidney function and damage along with evaluations of CVD sub-phenotypes using mobile health technologies. We will address these overarching goals with the following specific aims: Specific Aim 1: Conduct a longitudinal study of a CKD cohort of southwest AIs to identify unique risk factors for CKD and CVD progression and compare CKD and CVD event rates and risk factors between AI and other populations represented in CRIC; Specific Aim 2: Conduct ambulatory monitoring of kidney function and damage, and evaluate its relationship with exposure data; Specific Aim 3: Conduct CVD sub-phenotyping using mobile health technologies and evaluate its relationship with exposures data. This proposal takes advantage of the ongoing data collection and expertise of the CRIC study to address a gap in our understanding of CKD progression among AI. Ultimately, AI-CRIC will rapidly inform our understanding of the burden of CKD and provide disparity-reducing interventions. Importantly, the AI-CRIC addresses both an overarching goal of Healthy People 2020 to increase equity and reduce disparities and a priority issue for the American Society of Nephrology. OMB No. 0925-0001/0002 (Rev. 01/18 Approved Through 03/31/2020) Page Continuation Format Page