# Structural Racism as a "Third hit" on kidney outcomes of Black individuals with APOL1 risk alleles

> **NIH NIH K23** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $194,940

## Abstract

PROJECT SUMMARY
Black individuals have for decades been disproportionately impacted by kidney failure and rapid progression of
kidney disease when compared to their White counterparts. Black individuals with APOL1 high-risk alleles are
particularly vulnerable to accelerated chronic kidney disease (CKD) progression and kidney failure. However,
these high-risk genotypes only occur in about 12-14% of Black individuals, and they do not guarantee CKD
progression or kidney failure. Other risk factors, such as hypertension, HIV, and COVID-19, are thought to
confer additional second-hit risks. Structural racism (SR)—defined as discriminatory policies and practices
promoted through reinforcing systems (e.g., housing, wealth, health care) –– is also widely understood to be a
contributor to racial disparities in kidney health. I hypothesize that SR acts as a “third hit” which contributes to
excess risk of adverse kidney health outcomes among Black individuals with APOL1 risk alleles. Through four
complementary aims, I will characterize the effects of structural racism on kidney health among Black
individuals with high-risk APOL1 alleles and design and test a patient-centered intervention to mitigate effects
of SR on health outcomes. In Aim 1, I will engage a multidisciplinary stakeholder board to collaborate in the
analysis and interpretation of mixed-methods studies in Aims 2 and 3, and in the design and evaluation of a
patient-centered pilot intervention in Aim 4. In Aim 2, I will quantify the longitudinal effects of SR with poor
kidney health leveraging 3 large APOL1-enriched cohort studies. In Aim 3, I will characterize the experiences
of structural racism of Black patients with APOL1 who have CKD and their clinicians with SR in health settings
and their communities using qualitative analyses (photovoice, focus groups, semi-structured interviews).
In Aim 4, in collaboration with the stakeholder board, I will pilot a patient-centered, navigator-led intervention
designed to mitigate the effects of structural racism on kidney health. Throughout the award period, I will
pursue training in advanced epidemiologic and statistical science, including longitudinal analysis and multilevel
modeling, and develop skills in patient-centered clinical trial design and execution. Training goals and research
aims are aligned and integrated to support a holistic experience. The robust training and world-class
mentorship supported by this award, and Mount Sinai's enriched training environment and extensive
resources, will prepare me for a career as an independent investigator dedicated to mitigating the devastating
impact of structural racism on kidney health and eliminating kidney health disparities.

## Key facts

- **NIH application ID:** 10866289
- **Project number:** 1K23DK139454-01
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Dinushika Mohottige
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $194,940
- **Award type:** 1
- **Project period:** 2024-05-23 → 2029-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10866289

## Citation

> US National Institutes of Health, RePORTER application 10866289, Structural Racism as a "Third hit" on kidney outcomes of Black individuals with APOL1 risk alleles (1K23DK139454-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10866289. Licensed CC0.

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