Effect of Renal Insufficiency on Cardiovascular Outcomes

描述（来自申请的逐字记录）：心血管疾病账户 在接受维持治疗的患者中， 透析因为透析患者通常有晚期冠状动脉 与患者相比， 在肾功能正常的情况下，将获得最大的治疗效果 肾功能不全患者中，在他们 终末期肾病的发展和冠状动脉的早期发展 病变该提案将界定不同程度的慢性 肾功能不全对五年生存率的影响 冠心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 冠状动脉旁路移植术（CABG） 轻度、中度和重度肾功能不全。在评估这些临床 结果，本提案将估计五年累积医疗资源 患者的利用率（再住院和心脏手术）和成本 慢性肾功能不全和严重的冠状动脉疾病， 比较主要患者亚组的成本。回顾性队列设计将 用于利用杜克心血管疾病数据库 （DDCD），由杜克维护的大型综合患者数据库 临床研究所（DCRI）及其相关医院和医生 行政数据库。本研究将检查心血管结局 影响慢性肾功能不全患者的生存， 接受慢性透析的患者。这项研究的结果将提供 早期干预ESRD前人群的证据 最大限度地改善肾功能不全的冠心病疗效 血运重建和提高生存率。

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.