AFRICAN AMERICAN STUDY OF KIDNEY DISEASE AND HYPERTENSION COHORT

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。AASK队列研究是一项为期5年的前瞻性观察性研究，是非裔美国人肾脏疾病和高血压研究（AASK）临床试验的延伸，该试验测试了3种不同药物作为一线抗高血压治疗的效果。在AASK的1,094名随机参与者中，我们预计将有650-750名未达到终末期肾病（ESRD）的患者入组。此外，在AASK试验期间到达ESRD的个人将被邀请参加一次DNA采集。AASK队列研究的主要目的是前瞻性地确定患有高血压相关疾病并接受推荐抗高血压治疗的非裔美国人肾脏功能的长期病程和肾脏疾病进展的危险因素。次要目的是确定心血管疾病的发生，并评估高血压相关肾脏疾病的危险因素。将解决的研究问题如下：1。在这个人群中，肾功能的长期变化是怎样的？2. 预测肾脏疾病进展的环境、遗传、生理和社会经济因素是什么？3. asask试验干预对肾脏疾病进展的长期影响是什么？4. 蛋白尿的发生能预测肾脏疾病的进展吗？5. 根据AASK试验，与社区常规治疗相比，推荐的血压治疗对肾脏疾病进展的影响是什么？6. 高血压肾病患者有哪些合并症，特别是心血管疾病？7. 哪些危险因素可以预测心血管疾病的发生？8. 在ESRD前期到ESRD的转变过程中，代谢变量和心血管-肾脏危险因素的变化模式是什么？每年两次，大约每6个月收集一次暴露量。暴露将包括环境、遗传、生理和社会经济因素。主要肾脏结局将是由血清肌酐翻倍、ESRD或死亡确定的临床结局。所有没有ESRD的参与者将接受适当的降压治疗（血压低于140/90的ace抑制剂治疗方案）。以这种方式，该队列将直接控制肾脏疾病进展的两个主要“已知”决定因素（高血压治疗和使用肾保护，抗高血压药物），因此将在推荐的抗高血压护理设置中解决其研究目标。为了控制血压，我们预计最少接触4次，最多接触6次。队列研究的最短随访时间为5年。为患者提供血压控制药物，然而，发生的其他医疗状况将由研究者监测，但由其初级保健医生管理

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The AASK Cohort Study is a 5 year prospective, observational study that is an extension of the African-American Study of Kidney Disease and Hypertension (AASK) clinical trial that tested the effects of 3 different medications used as first line anti-hypertensive therapy. Of the 1,094 randomized participants in AASK, we anticipate that 650-750 individuals who have not reached End Stage Renal Disease (ESRD) will enroll. In addition, those individuals who reached ESRD during the AASK trial will be invited to attend one visit for collection of DNA. The primary objective of the AASK Cohort Study is to determine prospectively the long-term course of kidney function and risk factors for kidney disease progression in African-Americans with hypertension-related disease that receive recommended anti-hypertensive therapy. A secondary objective is to determine the occurrence of cardiovascular disease and assess its risk factors in the setting of hypertension-related kidney disease. Research questions that will be addressed are as follows: 1. What is the long-term course of kidney function in this population? 2. What are the environmental, genetic, physiologic, and socio-economic factors which predict the progression of kidney disease? 3. What are the long-term effects of the AASK trial interventions on the progression of kidney disease? 4. Does the development of proteinuria predict the progression of kidney disease? 5. What is the impact of recommended blood pressure therapy, as determined by the AASK trial, on the progression of kidney disease in comparison to usual care in the community? 6. What comorbidities, particularly cardiovascular disease, occur in the setting of hypertension related kidney disease? 7. What risk factors predict the occurrence of cardiovascular disease? 8. What are the patterns of change in metabolic variables and cardiovascular-renal risk factors during the transition from pre-ESRD to ESRD? Twice each year, approximately every 6 months, exposures will be collected. Exposures will include environmental, genetic physiologic, and socio-economic factors. The primary renal outcome will be a clinical outcome defined by doubling of serum creatinine, ESRD or death. Appropriate anti-hypertensive treatment (ACE-inhibitor containing regimens for blood pressures less than 140/90) will be provided to all participants who do not have ESRD. In this fashion, the cohort will directly control two of the major "known" determinants of kidney disease progression (treatment of hypertension and use of reno-protective, anti-hypertensive medication) and will therefore address its research objectives in the setting of recommended anti-hypertensive care. We anticipate a minimum of 4 contacts and maximum of 6 contacts for blood pressure control. The minimum duration of follow-up in the Cohort Study will be 5 years. Patients are provided medication for blood pressure management, however, other medical conditions that occur will be monitored by the investigator but managed by their primary care physician