Cohort Study of Chronic Renal Insufficiency

终末期肾病的发病率及其伴随的发病率、死亡率和护理费用每年都在持续上升。此外，慢性肾功能不全（CRI）患者患心血管疾病（CVD）的风险约为普通人群的30倍。本项目拟对3000例CRI患者进行队列随访，以确定与肾功能下降和CVD发生进展相关的因素。这将为制定减少这一高危人群CRI和CVD进展的策略奠定基础。本中心组建了一支由经验丰富的研究者组成的多学科团队，他们在招募和保留长期心血管和肾脏试验参与者方面具有文献记载的专业知识。我们中心的另一个优势是涵盖该地区绝大多数医疗保健市场的各种医疗保健系统之间的合作方法（克利夫兰诊所基金会，路易斯斯托克斯克利夫兰VAMC， Metrohealth医疗中心，俄亥俄永久医疗集团和克利夫兰大学医院）。已经确定，这些机构中有超过14,000名患者的血清肌酐水平记录在案，使他们有资格参加本研究。患者的识别和招募将符合目前有关保密的指导方针。基线评估将包括肾功能、流行的临床和亚临床心血管疾病的评估。将测量可能导致肾功能不全进展的相关患者、环境和获得卫生保健相关因素。传统的心血管危险因素，以及那些与潜在疾病和肾功能障碍相关的因素也将被评估。将对一部分患者进行中央动脉顺应性的一系列测量。患者将接受年度检查和每六个月一次的电话访谈。提出了肾脏和心血管疾病的临床相关结果。我们经验丰富的研究人员将有助于保留参与者和确定结果。

The incidence of End Stage Renal Disease, with its attendant morbidity, mortality and neaim care costs continues to rise every year. In addition, the risk of cardiovascular disease (CVD) is approximately 30 times higher in patients with chronic renal insufficiency (CRI) compared to the general population. This project proposes to follow a cohort of 3000 patients with CRI to determine the factors associated with decline in renal function and the development and progression of CVD. This will set the stage to develop strategies to reduce the progression of CRI and CVD in this high-risk population. This center has assembled a multidisciplinary team of experienced investigators with documented expertise in recruitment and retention of participants in long term cardiovascular and renal trials. Another strength of our center is the collaborative approach between the diverse health care systems encompassing the vast majority of the health care market in this area (Cleveland Clinic Foundation, Louis Stokes Cleveland VAMC, Metrohealth Medical Center, Ohio Permanente Medical Group, and University Hospitals of Cleveland). It has already been determined that over 14,000 patients in these institutions have a documented serum creatinine level that would make them eligible for participation in this study. Patient identification and recruitment will be consistent with current guidelines regarding confidentiality. Baseline evaluation will include assessment of renal function, and prevalent clinical and subclinical CVD. Relevant patient, environmental, and access to health care related factors that may contribute to progression of renal insufficiency will be measured. Traditional cardiovascular risk factors, as well as those associated with the underlying disease and renal dysfunction will also be assessed. Serial measurements of central arterial compliance will be performed in a subset of patients. Patients will be followed with annual examinations and phone interviews every six months. Clinically relevant outcomes of renal and cardiovascular disease are proposed. Our experienced research staff will be instrumental in the retention of participants and ascertainment of outcomes.