Stroke and its implications across the spectrum of chronic kidney disease

 描述（由申请人提供）：拟议项目将解决重要的公共卫生问题，与国家糖尿病、消化和肾脏疾病研究所（NIDDK）的使命高度相关，涉及晚期慢性肾脏疾病患者的卒中负担和卒中相关临床结局（即，CKD 4期和5期）和需要透析的终末期肾病（ESRD）。在全球范围内，有数百万患者患有CKD 4-5和需要透析的ESRD，预计这一数字在未来几十年内将大幅增长。中风在这类患者中很常见，但许多与中风相关的问题仍未得到探讨。拟议项目的目的是（1）确定中风率如何随着肾脏疾病的发生而变化;（2）创建一个动态风险计算器，以量化死亡、复发性中风和中风后透析生存的竞争风险;（3）通过确定中风后出院回家与到专业护理机构的比率来量化中风后临床过程，卒中后30天和90天全因再入院率，以及与这些结果相关的因素;（4）探讨电子心律监测设备目前如何用于心律失常的检测，以改善CKD患者卒中的一级预防。这项工作将通过使用美国肾脏数据系统和医疗保险和医疗补助服务中心提供的综合管理数据库创建CKD和透析患者的大型回顾性队列来完成。将使用多变量和竞争风险统计技术对各种风险因素与临床重要结局之间的关系进行建模，从而进行临床推断并生成关键信息，这些信息可用于告知患者和医生之间关于卒中对患者健康状况影响的对话。

 DESCRIPTION (provided by applicant): The proposed project will address important public health questions, highly relevant to the mission of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about stroke burden and stroke-related clinical outcomes in patients with advanced chronic kidney disease (i.e., CKD stages 4 and 5) and with dialysis-requiring end stage renal disease (ESRD). Worldwide, several million patients have CKD 4-5 and dialysis-requiring ESRD, a number which is expected to grow substantially in coming decades. Stroke is common in such patients, but many stroke-related questions remain unexplored. The aims of the proposed project are to (1) determine how stroke rates change as kidney disease worsens; (2) create a dynamic risk calculator to quantify the competing risks of death, recurrent stroke, and survival on dialysis following a stroke; (3) quantify the post-stroke clinical course by determining rates of discharge to home versus to a skilled nursing facility afte a stroke, rates of 30- and 90-day all-cause hospital readmissions after stroke, and the factors associated with these outcomes; and (4) explore how electronic heart rhythm-monitoring devices are currently used for the detection of arrhythmias in order to improve primary stroke prevention in CKD patients. The work will be accomplished by creating large, retrospective cohorts of CKD and dialysis patients via use of comprehensive administrative databases provided by the United States Renal Data System and the Centers for Medicare and Medicaid Services. Multivariable and competing-risk statistical techniques will be used to model relationships between various risk factors and clinically- important outcomes, permitting clinical inferences to be made and generating key information which can be used to inform conversations between patients and physicians about the implications of stroke on patient health status.