A Triple Marker Approach To Optimize CKD Detection Among Black and White Adults

优化黑人和白人成人 CKD 检测的三重标记方法

• 批准号: 8517114
• 负责人: Carmen Alicia Peralta
• 金额: $ 14.3万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517114
• 关键词: Adult; Affect; Age; Aging; Albumins; Albuminuria; Atherosclerosis; Body Composition; Cardiovascular system; Cessation of life; Characteristics; Chronic Disease; Chronic Kidney Failure; Clinical; Computerized Medical Record; Consensus; Coronary artery; Creatinine; Data; Detection; Development; Diabetes Mellitus; Diagnosis; Early Diagnosis; Early treatment; Elderly; End stage renal failure; Epidemiology; Equation; Ethnic Origin; Ethnic group; Evaluation; Event; Filtration; Funding; General Practices; Glomerular Filtration Rate; Goals; Grant; Guidelines; Health; Health Surveys; Heart failure; High Prevalence; Hypertension; Individual; Injury; Investigation; Kidney; Kidney Diseases; Knowledge; Label; Laboratories; Lead; Measures; Meta-Analysis; Morbidity - disease rate; National Health and Nutrition Examination Survey; Nephrology; Nutrition Surveys; Obesity; Persons; Population Heterogeneity; Prevalence; Prevention; Prevention program; Prevention strategy; Probability; Race; Relative (related person); Renal function; Reporting; Research; Resources; Risk; Risk Factors; Serum; Stratification; Stroke; Testing; United States National Institutes of Health; Urine; Work; aged; base; clinical practice; cohort; design; diabetic; disorder prevention; disorder risk; ethnic minority population; high risk; impaired glucose tolerance; improved; muscle form; non-diabetic; post gamma-globulins; programs; racial difference; screening; sex; tool; young adult

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is highly morbid, and it affects race/ethnic minorities disproportionately. Early detection and treatment are the cornerstones of prevention epidemiology. Yet to date, there is no consensus for CKD screening among persons without diabetes. The current clinical strategy among non-diabetics relies on serum creatinine for diagnosing CKD, and this strategy misses many persons at risk. In fact, 1 in 6 adults in the U.S. may have undetected CKD despite having creatinine measured. Serum creatinine is biased by age and race, which results in the inability to reliably detect CKD across age and race/ethnic groups. Despite the availability of an established marker of kidney injury such as albumin-to-creatinine ratio (ACR) and an alternative filtration marker, cystatin C, these are not routinely recommended or used in general clinical practice. These markers have been shown to improve CKD risk stratification, but their utility in CKD screening is not known. ACR and cystatin C can detect CKD that is missed by creatinine (occult CKD) in up to 16% of U.S. adults. Persons with occult CKD are at high risk for death, cardiovascular events and progression to ESRD. The use of a triple marker approach of creatinine, cystatin C, and ACR to detect CKD has not been studied. Moreover, the absence of evidence to determine who would benefit most from CKD screening prohibits investigation of targeted screening programs. Without effective screening programs, our ability to detect CKD and to design and evaluate prevention strategies is limited. This application proposes a paradigm shift in the field of CKD prevention by developing the knowledge necessary to design, evaluate and implement effective CKD screening strategies across diverse populations. Specifically, we propose to pool data from four large, ongoing, NIH-funded cohorts that represent over 27,000 Black and White persons aged 28-84: the Coronary Artery Risk Development in Young Adults (CARDIA), Multi-Ethnic Study of Atherosclerosis (MESA), Reasons for Geographical and Racial Differences in Stroke (REGARDS), and the Health, Aging and Body Composition (Health ABC) Studies. We propose to use these pooled data to implement a triple marker approach to investigate the prevalence of occult CKD among non-diabetics. We will evaluate the numbers needed to screen to detect occult CKD by cystatin C or ACR. Our second goal is to evaluate risk factors associated with occult CKD overall and by age, sex and race/ethnicity. We will then develop a prediction tool for occult CKD and a clinician-friendly, online calculator to estimate an individual's probability of having occult CKD. The data generated from these projects can directly lead to the evaluation of screening strategies that are targeted to individual risk.

描述（由申请人提供）：慢性肾脏疾病（CKD）病态高，并且对种族/族裔少数民族的影响不成比例。早期检测和治疗是预防流行病学的基石。然而，迄今为止，在没有糖尿病的人之间尚无共识。非糖尿病患者之间的当前临床策略依赖于血清肌酐来诊断CKD，而该策略则错过了许多处于危险中的人。实际上，尽管测量了肌酐，但在美国，有六分之一的成年人可能未被发现。血清肌酐受到年龄和种族的偏见，这导致无法可靠地检测到跨年龄和种族/种族群体的CKD。尽管有既定的肾脏损伤标记物，例如白蛋白与促甲酸比率（ACR）和替代过滤标记Cystatin C，但并未通常在一般临床实践中使用或使用这些标记。这些标记已被证明可以改善CKD风险分层，但是它们在CKD筛选中的效用尚不清楚。 ACR和Cystatin C可以检测到多达16％的美国成年人中肌酐（Scucult CKD）错过的CKD。具有神秘性CKD的人有死亡，心血管事件和向ESRD发展的高风险。尚未研究肌酐，胱抑素C和ACR检测CKD的三重标记方法。此外，缺乏确定谁能从CKD筛查中受益最大的证据禁止对目标筛查计划进行调查。如果没有有效的筛选计划，我们检测CKD并设计和评估预防策略的能力是有限的。该应用程序提出，通过开发设计，评估和实施各种人群中有效的CKD筛查策略所必需的知识，提出了预防CKD领域的范式转变。具体而言，我们建议从四个大型，正在进行的NIH资助的队列中汇集数据，这些数据代表了27,000多名黑人和白人28-84岁：年轻人的冠状动脉风险发展（Cardia），动脉粥样硬化的多族裔研究（MESA）（MESA）（MESA），地理和种族差异的原因（MESA），在Stroke（STROKE（Stroke）（stroke（cambark）和身体构成）和身体构成（abc）和身体健康，肥胖（ABS）和肥胖（ag）（肥胖）。我们建议使用这些汇总数据来实施三重标记方法，以研究非糖尿病患者的隐匿性CKD的患病率。我们将评估筛选通过Cystatin C或ACR检测隐匿性CKD所需的数字。我们的第二个目标是评估与隐匿性CKD总体以及年龄，性别和种族/种族相关的风险因素。然后，我们将开发一个用于隐匿性CKD和临床医生友好的在线计算器的预测工具，以估计个人具有隐匿性CKD的可能性。这些项目产生的数据可以直接导致评估针对个人风险的筛选策略。