PROJECT SUMMARY/ ABSTRACT Compared to non-Latinx White individuals, Latinx individuals (gender-inclusive term; includes Hispanics, Latino/a/e) have 2-times the risk of kidney failure and face a disproportionate burden of structural racism and kidney health disparities. Latinx individuals are less likely to receive pre-dialysis nephrology care compared to non-Latinx White individuals and as a result, are less likely to initiate person-centered kidney replacement therapy (KRT), such as kidney transplantation or home dialysis. Latinx individuals are instead more likely than non-Latinx White individuals to begin KRT with a central venous catheter, which has a higher risk of mortality (1.4-1.5-fold) and fatal infection (1.5-2-fold) compared to an arteriovenous fistula or graft. Our community- partnered research team developed and tested NAVIGATE-Kidney, a multi-level, language and culturally concordant community health worker (CHW) intervention for Latinx individuals with kidney failure who receive maintenance hemodialysis. Our funded parent grant (U01 DK137272-01) allows us to move beyond dialysis center interventions by providing support to Latinx individuals with chronic kidney disease (CKD) stage 4/5. Our team will conduct a patient-level randomized controlled trial of NAVIGATE-Kidney that will be implemented across socioecological levels (individual, interpersonal, community, and societal) to mitigate structural racism. We hypothesize that our NAVIGATE-Kidney intervention will reduce the composite primary endpoint, defined as time to transition to KRT and central venous catheter use or death. In our plan for enhancing diverse perspectives (PEDP), our team proposed mentorship of diverse nephrology physician scientists, trainees, and CHWs as well as development of a kidney disease CHW training program. The PI, Dr. Lilia Cervantes, is a nationally renowned leader in Latinx kidney disease health disparities research, who provides one to one mentorship to nephrology scientists whose research and goals to eliminate structural racism align with her own. This supplement will provide Dr. Cervantes with the protected time to provide mentorship to mentees on how to conduct community-partnered research, grant writing, publications, technical skills development including dissemination and implementation activities, and opportunities for networking. We also propose to utilize supplement funds to support the team that will build the kidney disease CHW training program. This training program will provide CHWs with the disease specific training for principal illness navigation certification (required by the Centers for Medicare and Medicaid Services for reimbursement) and in doing so, will increase diversity in kidney disease clinical trials, CHW intervention research, and the CHW research workforce. The work proposed in this supplement aligns seamlessly with our parent grant PEDP, expands the research proposed in our parent grant and the structural racism parent...