Role of pre-ESRD blood pressure management on post-ESRD outcomes

描述(申请人提供)：尽管慢性肾脏病(CKD)是终末期肾病(ESRD)的先兆，但很少有关于ESRD预后的研究捕捉到CKD期间发生的事件的信息。因此，基本和重要的问题仍然没有得到回答。例如，CKD疾病阶段的干预措施如何影响ESRD疾病阶段的结果？这项研究的主要目的是了解终末期肾病患者的死亡风险是否以及如何受到CKD期间严格的血压控制的影响。为了实现这一目标，我们将研究NIH赞助的两个已完成的随机对照试验的参与者：肾脏疾病中饮食的修改(MDRD)研究和非裔美国人肾脏疾病和高血压研究(AASK)。MDRD和AASK都在疾病的CKD阶段登记了患者，但许多参与者后来患上了ESRD，他们在ESRD后的结果可以通过美国肾脏疾病系统(USRDS)进行跟踪，这是一个全国性的ESRD登记系统。我们的研究方法和研究设计使我们有机会研究疾病CKD阶段的其他治疗选择如何影响ESRD后的结果。通过将USRDS与MDRD和AASK联系起来，我们将对导致ESRD患者不良结局发生率高的可改变的危险因素有新的认识。我们的结果可能会为CKD患者的血压控制应该如何严格的争论提供信息，并指导肾脏疾病患者的营养管理和其他方面的护理。

DESCRIPTION (provided by applicant): Although chronic kidney disease (CKD) is the precursor to end-stage renal disease (ESRD), few studies of outcomes after ESRD have captured information about events that occurred during CKD. Basic and important questions therefore remain unanswered. For example, how do interventions during the CKD phase of disease affect outcomes at the ESRD phase of disease? The major goal in this study is to understand whether and how mortality risk among ESRD patients is affected by tightness of blood pressure control during CKD. To achieve this, we will study enrollees of two completed NIH-sponsored randomized controlled trials: the Modification of Diet in Renal Disease (MDRD) study and the African American Study of Kidney Disease and Hypertension (AASK). Both MDRD and AASK enrolled patients during the CKD phase of disease, but numerous participants went on to develop ESRD and their post- ESRD outcomes can be tracked via United States Renal Disease System (USRDS), the nationally comprehensive ESRD registry. Our research approach and study design lends opportunities to examine how other therapeutic choices during the CKD phase of disease will affect outcomes after ESRD. By linking USRDS with MDRD and AASK, we will gain new insight into modifiable risk factors contributing to the high rates of adverse outcomes among patients with ESRD. Our results may inform the debate about how tightly blood pressure should be managed among CKD patients as well as guide nutrition management and other aspects of care in kidney disease patients.