Effect of Renal Insufficiency on Cardiovascular Outcomes

描述（申请中的逐字记录）：心血管疾病账户 接受维持治疗的患者死亡报告中几乎有一半是这样的 透析。因为意外透析患者通常患有晚期冠状动脉疾病 与患者相比，动脉疾病更难治疗 肾功能正常时，治疗效果最大 通过在肾功能不全患者中发明，在他们之前 ESRD 的发展和冠状动脉发展的早期 病变。该提案将定义不同程度的慢性病的影响 肾功能不全对患者五年生存率的影响 冠状动脉疾病。这项研究将进一步比较患者的生存率 冠状动脉疾病治疗后（药物、经皮冠状动脉 动脉介入治疗和冠状动脉搭桥术） 轻度、中度和重度肾功能不全。在评估了这些临床结果后 结果，该提案将估算五年累计医疗资源 患者的利用率（再住院和心脏手术）和费用 患有慢性肾功能不全和严重冠状动脉疾病 比较主要患者亚组之间的成本。回顾性队列设计将 用于利用杜克大学心血管疾病数据库 (DDCD)，一个大型、综合的患者数据库，由杜克大学维护 临床研究所 (DCRI) 及其附属医院和医生 行政数据库。这项研究将检查心血管结果 影响慢性肾功能不全患者的生存 接受长期透析的患者。这项研究的结果将提供 对患有慢性疾病的终末期肾病前期人群进行早期干预的证据 最大限度提高肾功能不全冠脉疗效 血运重建并提高生存率。

DESCRIPTION (Verbatim from the application): Cardiovascular disease accounts for almost half of the reported deaths for patients receiving maintenance dialysis. Because incident dialysis patients often have advanced coronary artery disease that is less amenable to treatment as compared with patients with normal renal function, the greatest impact of therapy will be obtained through invention among patients with renal insufficiency, prior to their development of ESRD and earlier in the development of the coronary artery lesions. This proposal will define the impact of varying degrees of chronic renal insufficiency on five-year survival among patients with significant coronary artery disease. This study will further compare patient survival following treatment for coronary artery disease (medical, percutaneous coronary artery intervention and coronary artery bypass grafting) among patients with mild, moderate, and severe renal insufficiency. After evaluating these clinical outcomes, this proposal will estimate the cumulative five-year medical resource utilization (rehospitalizations and cardiac procedures) and costs for patients with chronic renal insufficiency and significant coronary artery disease to compare costs among major patient subgroups. A retrospective cohort design will be used to take advantage of the Duke Databank for Cardiovascular Diseases (DDCD), a large, comprehensive patient database, maintained by the Duke Clinical Research Institute (DCRI) and its associated hospital and physician administrative databases. This study will examine the cardiovascular outcomes that affect the survival of patients with chronic renal insufficiency and patients receiving chronic dialysis. The results of this study will provide evidence for early intervention among the pre-ESRD population with chronic renal insufficiency to improve maximize the efficacy of coronary revascularization and improve survival.