PROJECT SUMMARY/ABSTRACT: Through this K23 award, Dr. Anthony Muiru will obtain the knowledge, skills, and expertise necessary to become a leading investigator in patient-oriented clinical research of chronic kidney disease (CKD) and elevated blood pressure (BP) among people of recent African ancestry. During his renal fellowship, he leveraged the infrastructure of the Sustainable East Africa Research in Community Health (SEARCH) study to define the epidemiology of CKD in rural East Africa. He established the SEARCH-CKD study, comprising a representative sample of 3,686 SEARCH participants from rural Uganda and Kenya. Key findings from initial work in SEARCH-CKD included: 1) High prevalence of unexplained leukocyturia and hematuria; 2) a striking geographic variation in CKD prevalence; and 3) high prevalence of elevated BP among individuals with CKD. Dr. Muiru intends to follow up on these initial SEARCH-CKD findings to achieve the following goals: 1) transform SEARCH-CKD from a cross-sectional study into a longitudinal cohort study; 2) gain hands-on experience in longitudinal cohort management, collection of bio-samples and subsequent measurement of analytes; 3) acquire expertise in advanced epidemiological and biostatistical methods, environmental epidemiology; and 4) obtain certification as a hypertension specialist. To achieve these goals, Dr. Muiru has assembled a multidisciplinary team of mentors and advisors, he will enroll in a customized selection of courses, and will continue to leverage the infrastructure established by the SEARCH study. CKD leads to elevated BP and elevated BP in turn accelerates CKD progression. The burden of these two conditions is growing dramatically in sub-Saharan Africa. This K23 award will allow Dr. Muiru to address key knowledge gaps in regard to CKD and elevated BP in rural East Africa and provide him with the support and mentorship necessary to accomplish the following aims: 1) determine the significance of leukocyturia and hematuria observed among individuals living in rural East Africa; 2) examine potential risk factors for CKD that may explain the geographic variation in CKD prevalence in rural East Africa, 3) define BP phenotypes among participants with CKD (~half HIV-positive) by obtaining standardized single time-point BP measurement followed by 24-hr ambulatory blood pressure measurement. This proposal will provide Dr. Muiru with an invaluable training platform that will propel him into an independent research career. In addition, the proposed research will advance our understanding of kidney disease and elevated BP among people of recent African ancestry.