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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

基本信息

批准号：
8727540
负责人：
Carmen Alicia Peralta
金额：
$ 18.53万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8727540
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

项目摘要

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）是一种高度病态的疾病，它对种族/少数民族的影响不成比例。早期发现和治疗是预防流行病学的基石。然而到目前为止，在没有糖尿病的人群中进行CKD筛查还没有达成共识。目前非糖尿病患者的临床策略依赖于血清肌酐来诊断CKD，这一策略忽略了许多高危人群。事实上，在美国，尽管测量了肌酐，但六分之一的成年人可能未检测到CKD。血清肌酐受年龄和种族的影响，导致无法可靠地检测不同年龄和种族/民族的CKD。尽管有一种确定的肾损伤标志物，如白蛋白与肌酐比值（ACR）和另一种过滤标志物胱抑素C，但这些都不被常规推荐或在一般临床实践中使用。这些标志物已被证明可以改善CKD风险分层，但它们在CKD筛查中的效用尚不清楚。ACR和胱抑素C可以检测到高达16%的美国成年人肌酐未检测到的CKD（隐匿性CKD）。隐匿性CKD患者死亡、心血管事件和进展为ESRD的风险很高。使用肌酸酐、胱抑素C和ACR的三重标记方法检测CKD尚未进行研究。此外，缺乏证据来确定谁将从CKD筛查中获益最多，这也阻碍了对目标筛查项目的调查。如果没有有效的筛查程序，我们检测CKD以及设计和评估预防策略的能力是有限的。该应用程序通过开发设计、评估和实施不同人群有效的CKD筛查策略所需的知识，提出了CKD预防领域的范式转变。具体来说，我们建议汇集来自四个大型的、正在进行的、美国国立卫生研究院资助的队列的数据，这些队列代表了27,000多名年龄在28-84岁之间的黑人和白人：年轻人冠状动脉风险发展（CARDIA）、动脉粥样硬化多种族研究（MESA）、中风的地理和种族差异原因（REGARDS）和健康、衰老和身体成分（Health ABC）研究。我们建议使用这些汇总数据来实施三重标记方法来调查非糖尿病患者中隐匿性CKD的患病率。我们将评估通过胱抑素C或ACR筛查隐匿性CKD所需的数量。我们的第二个目标是评估与隐蔽性CKD相关的风险因素，并按年龄、性别和种族/民族进行评估。然后，我们将开发一个隐匿性CKD的预测工具和一个临床友好的在线计算器，以估计个人患有隐匿性CKD的概率。这些项目产生的数据可以直接用于评估针对个体风险的筛查策略。