Cardiac and Renal Disease Study (CARDS)

描述(由申请人提供)： 轻至中度慢性肾功能不全(CRI)正在流行 美国的比例。与轻中度CRI和 心血管风险是有限的，而且不一致。尽管我们已经了解到 更多地了解与终末期相关的自然病史和不良后果 肾脏疾病(ESRD)，我们几乎没有关于风险的具体信息 肾脏疾病发生或发展的因素。 使用以人口为基础、种族多样化的大量男性和女性队列 对于有长期跟踪的健康计划参与者，我们建议：目标1：评估： A)超时基线和肾功能下降是否独立 冠心病(CHID)、中风、心力衰竭和 外周血管疾病；b)这些关系的效应修饰物， 包括基线高血压和糖尿病状况。目标2：确定 血压水平是否在基线和随时间增加(以及 流行的和偶发的高血压)预测随后的风险 调整了糖尿病和基线血肌酐后的ESRD， 蛋白尿和血尿。目标3：检查其他潜在的预测因素 ESRD包括人口因素(种族/民族、教育水平)总计 胆固醇水平、肾脏疾病家族史、体重指数、矢状面 腹径、香烟(以及雪茄和烟斗)、吸烟、咖啡 摄入量、饮酒量、肾脏疾病家族史和自我报告 职业接触。 我们将利用北区现有的纵向数据资源 加州Kaiser Permanente研究和可用患者级别分部 与美国肾脏数据系统终末期肾脏疾病登记的交叉链接 以获得全面的肾脏和心血管结果。从头开始 这种规模和持续时间的前瞻性研究将是令人望而却步的 既昂贵又耗时。这项提议将利用独特的资源 和方法学专业知识，为流行病学提供新的见解 肾脏疾病及其与心血管事件的关联。

DESCRIPTION (provided by applicant): Mild-to-moderate chronic renal insufficiency (CRI) is reaching epidemic proportions in the US. Studies relating mild-to-moderate CRI and cardiovascular risk are limited and inconsistent. Although we have learned much about the natural history and adverse outcomes associated with end-stage renal disease (ESRD), we have little specific information regarding risk factors for the development or progression of renal disease. Using a population-based, ethnically diverse large cohort of male and female health plan enrollees with extended follow-up, we propose: Aim 1: To evaluate: a) whether baseline and decline in renal function overtime are independent predictors of coronary heart disease (CHID), stroke, heart failure and peripheral vascular disease; b) effect modifiers of these relationships, including baseline hypertension and diabetes status. Aim 2: To determine whether baseline and increase over time in blood pressure level (as well as prevalent and incident hypertension) are predictive of the subsequent risk of ESRD after adjusting for diabetes and for baseline serum creatinine, proteinuria and hematuria. Aim 3: To examine other potential predictors of ESRD including demographic factors (race/ethnicity, level of education) total cholesterol level, family history of renal disease, body mass index, sagittal abdominal diameter, cigarette (as well as cigar and pipe) smoking, coffee intake, alcohol consumption, family history of renal disease and self-reported occupational exposures. We will take advantage of existing longitudinal data resources at the Northern California Kaiser Permanente Division of Research and available patient-level cross-linkage with the US Renal Data System end-stage renal disease registry to obtain comprehensive renal and cardiovascular outcomes. A de novo prospective study of this magnitude and duration will be prohibitively expensive and time-consuming. This proposal will leverage unique resources and methodological expertise to provide novel insights into the epidemiology of renal disease and its association with cardiovascular events.