Refining Estimates of Kidney Function in the U.S.

完善美国肾功能的估计

• 批准号: 7263858
• 负责人: JOSEF CORESH
• 金额: $ 13.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-15 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7263858
• 关键词: African American; Age; Area; Benchmarking; Biological Assay; Body Composition; Calibration; Caring; Characteristics; Chronic Kidney Failure; Classification; Clinical; Clinical Trials; Collaborations; Collection; Cost of Illness; Creatinine; Data; Development; Diabetes Mellitus; Diet; Diet Modification; Dietary Proteins; Equation; Ethnic Origin; Ethnic group; Evaluation; Freezing; Future; Glomerular Filtration Rate; Goals; Healthy People 2010; High Prevalence; Hypertension; Individual; Influentials; Investigation; Iothalamate; Kidney Diseases; Laboratories; Manuscripts; Measurement; Measures; Methods; Minority; Muscle; NIH Program Announcements; National Health and Nutrition Examination Survey; Numbers; Outcome; Participant; Patients; Phase; Policies; Population; Prevalence; Prevention; Race; Range; Renal function; Reporting; Research; Sample Size; Sampling; Serum; Subgroup; Surveys; Thinking; Time; Visit; base; follow-up; improved; kidney disease education; post gamma-globulins; programs; sex; trend

DESCRIPTION (provided by applicant): Accurately estimating glomerular filtration rate (GFR) is central to the study, prevention and treatment of chronic kidney disease (CKD). Serum cystatin C (CysC) may provide a better estimate of GFR than serum creatinine (sCr). In order to determine if CysC is better, a large study using uniform measurements of sCr, CysC, and a wide range of participant characteristics is needed. This will allow for the development of an equation for estimating GFR from CysC and for rigorous evaluation of the newly developed equation for CysC as compared to equations using sCr to estimate GFR. In Phase I (1 year R21), we will (1) assay CysC in frozen serum from a large multi-ethnic group of clinical trial participants and screenees (n=1668 AASK and 1041 MDRD study baseline and 633 AASK and 433 MDRD study 2-year follow-up visits) with standardized measurements of 125I-iothalamate GFR, sCr and CysC in a single laboratory; (2) develop an equation to estimate GFR from CysC; and (3) compare this equation to equations using sCr with respect to bias, precision and simplicity and assess its generalizability. We will use the MDRD 4-variable equation which includes sCr, age, sex, and race as a benchmark with which to compare the newly developed CysC equation. We propose to proceed to the R33 phase if the newly developed CysC equation does not require adjustment for age, sex, race, body composition or diet, and this equation shows better accuracy overall or in predefined subgroups as compared to the MDRD 4-variable equation. In Phase II (2 year R33), we will (1) assay CysC in frozen serum from 8,804 NHANES III (1988-1994) and 5,135 NHANES 1999-2000 participants age 12+ years; (2) estimate the prevalence of decreased kidney function and CKD in these surveys using the newly developed CysC equation for estimating GFR; and (3) compare estimates from the CysC equation and sCr equations. We hypothesize that the overall prevalence of decreased kidney function and chronic kidney disease (CKD) will be similar, but differences will exist for specific subgroups. These CysC data will be made publicly available allowing for improved study of estimated kidney function, its correlates and consequences in these NHANES surveys. Estimation of kidney function has been at the core of most clinical trials of the progression of CKD and estimates of the high prevalence of decreased kidney function in the US population have been influential. This large and rigorous evaluation of whether CysC can improve estimation of GFR in individuals and the population should have a high impact on research, practice and policy related to CKD--meeting the goals of this program announcement.

描述(由申请人提供)： 准确估计肾小球滤过率(GFR)对慢性肾脏疾病(CKD)的研究、预防和治疗具有重要意义。血清胱抑素C(CysC)可能比血清肌酐(Scr)更好地估计肾小球滤过率。为了确定CysC是否更好，需要对Scr、CysC和广泛的参与者特征进行统一测量的大型研究。这将允许开发从CysC估计GFR的公式，并与使用SCR估计GFR的公式相比，对新开发的CysC公式进行严格评估。 在第一阶段(1年R21)，我们将(1)在单个实验室通过标准化测量125I-异硫代氨基甲酸酯GFR、Scr和CysC来检测来自大型多种族临床试验参与者和筛查对象(n=1668名AASK和1041名MDRD研究基线以及633名AASK和433名MDRD研究两年随访)中的冷冻血清中的CysC；(2)开发根据CysC估计GFR的公式；以及(3)在偏倚、精确度和简单性方面将该公式与使用SCR的公式进行比较，并评估其普适性。我们将使用包括Scr、年龄、性别和种族的MDRD 4变量方程作为基准，与新开发的CysC方程进行比较。如果新开发的CysC方程不需要对年龄、性别、种族、身体成分或饮食进行调整，并且与MDRD 4变量方程相比，该方程在总体上或在预定义的子组中显示出更好的准确性，我们建议进入R33阶段。在第二阶段(2年R33)，我们将(1)测定8,804名NHANES III(1988-1994)和5,135名NHANES 1999-2000年12岁以上参与者的冷冻血清中的CysC；(2)在这些调查中使用新开发的用于估计GFR的CysC方程来估计肾功能减退和CKD的患病率；以及(3)比较CysC方程和Scr方程的估计。我们假设肾功能减退和慢性肾脏疾病(CKD)的总体患病率将是相似的，但在特定的亚组中存在差异。这些CysC数据将公之于众，以便在这些NHANES调查中改进对估计的肾功能、其相关性和结果的研究。对肾功能的评估一直是CKD进展的大多数临床试验的核心，对美国人群中肾功能下降的高流行率的估计也产生了影响。这项关于CysC是否可以改善个人和人群中GFR估计的大规模而严格的评估，应该会对与CKD相关的研究、实践和政策产生很大影响--实现本计划宣布的目标。

项目成果

Within-person variability in kidney measures.

• DOI: 10.1053/j.ajkd.2012.11.048
• 发表时间: 2013-05
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Selvin E;Juraschek SP;Eckfeldt J;Levey AS;Inker LA;Coresh J
• 通讯作者: Coresh J

Novel filtration markers as predictors of all-cause and cardiovascular mortality in US adults.

• DOI: 10.1053/j.ajkd.2013.01.016
• 发表时间: 2013-07
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Foster MC;Inker LA;Levey AS;Selvin E;Eckfeldt J;Juraschek SP;Coresh J;CKD Biomarkers Consortium
• 通讯作者: CKD Biomarkers Consortium

Decreased kidney function in the elderly: clinical and preclinical, neither benign.

老年人肾功能下降：临床和临床前，都不是良性的。

• DOI: 10.7326/0003-4819-145-4-200608150-00010
• 发表时间: 2006
• 期刊: Annals of internal medicine
• 影响因子: 39.2
• 作者: Coresh,Josef;Astor,Brad
• 通讯作者: Astor,Brad

Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates.

• DOI: 10.1053/j.ajkd.2013.03.013
• 发表时间: 2013-08
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Grams ME;Juraschek SP;Selvin E;Foster MC;Inker LA;Eckfeldt JH;Levey AS;Coresh J
• 通讯作者: Coresh J

The effects of freeze-thaw on β-trace protein and β2-microglobulin assays after long-term sample storage.

• DOI: 10.1016/j.clinbiochem.2012.02.027
• 发表时间: 2012-06
• 期刊: Clinical biochemistry
• 影响因子: 2.8
• 作者: Juraschek SP;Coresh J;Inker LA;Rynders GP;Eckfeldt JH;Selvin E
• 通讯作者: Selvin E