Hispanic Chronic Renal Insufficiency Cohort(CRIC) Study

项目总结/摘要 尽管在美国患有终末期肾病的西班牙裔人口急剧增长，相对较少 已知西班牙裔慢性肾病（CKD）的早期阶段。西班牙裔慢性肾衰竭 不充分队列（CRIC）研究是基于伊利诺伊大学芝加哥分校，是一项辅助研究， NIDDK赞助的多中心CRIC研究。在前两个资助期内，该研究收集了一份 一个相当大的西班牙裔中重度CKD队列，并解决了关键问题。一个关键发现 与非西班牙裔白人相比，西班牙裔CKD患者的社会经济地位较低， 血压控制较差，抑郁症状加重，健康相关生活质量（HRQOL）降低。 此外，我们发现患有CKD的西班牙裔患者的CKD进展率高出两倍，但这一点并不重要。 差异的解释是潜在的可改变的社会人口和临床因素。这一发现 对实践的重要影响，并强调需要更好地了解影响风险因素的因素 控制和健康结果。由于我们的研究结果，这种竞争性的科学范围 更新已经扩大到解决以下领域的知识差距：1）轻度CKD的流行病学， 2)社会文化/心理社会因素对慢性肾脏病进展和心血管事件的影响 西班牙裔，和3）CKD进展对以患者为中心的结局的影响。首先，因为个人 轻度慢性肾病在慢性肾病人群中所占比例要大得多，这提高了我们对可改变的了解 早期疾病的风险因素可能对公共卫生产生重大影响。认识到需要 为了了解轻度CKD的流行病学，CRIC研究最近招募了1500名成年人， eGFR 45-70 ml/min/1.73m2。然而，这些参与者中只有4%是西班牙裔。二是 积累的证据表明，社会文化和心理社会因素影响健康结果， 西班牙裔，但这些因素尚未在CKD的背景下进行研究。第三，除了学习 传统的临床结果，越来越多的人认识到需要研究患者定义的结果， 变得重要这项申请旨在继续跟踪现有的西班牙裔审评委队列，并丰富其内容。 招募125名患有轻度CKD（eGFR 45-70 ml/min/1.73 m2）的西班牙裔患者，以完成以下任务 目的：1）评价西班牙裔与CKD进展和心血管事件风险的相关性 在轻度CKD成人中; 2）调查社会文化和心理社会因素与CKD的相关性 西班牙裔CKD严重程度谱中的进展和心血管事件;以及3） 检查CKD进展与以患者为中心的结局的关系（例如，HRQOL、身体机能、 疼痛）在西班牙裔和种族/民族群体中的CKD严重程度谱中。的更新 西班牙裔审评委及其与母公司审评委研究的持续密切联系提供了前所未有的机会， 有效地解决了关于西班牙裔CKD流行病学的广泛关键问题。

Project Summary/Abstract Despite the dramatic growth of the Hispanic population with end stage renal disease in the U.S., relatively little is known about earlier stages of chronic kidney disease (CKD) in Hispanics. The Hispanic Chronic Renal Insufficiency Cohort (CRIC) Study is based at the University of Illinois at Chicago and is an ancillary study to the NIDDK-sponsored multi-center CRIC Study. During the first two funding periods, the study assembled a sizable cohort of Hispanics with moderate to severe CKD and addressed critical questions. One key finding was that compared to non-Hispanics whites, Hispanics with CKD are burdened by lower socioeconomic status, poorer blood pressure control, higher depressive symptoms, and lower health-related quality of life (HRQOL). Furthermore, we found that Hispanics with CKD experienced a twofold higher rate of CKD progression but this disparity was explained by potentially modifiable sociodemographic and clinical factors. This finding has important implications for practice and underscores the need to better understand factors influencing risk factor control and health outcomes in Hispanics. As a result of our findings, the scientific scope of this competitive renewal has been broadened to address knowledge gaps in the following areas: 1) epidemiology of mild CKD, 2) impact of sociocultural/ psychosocial factors on CKD progression and cardiovascular events among Hispanics, and 3) influence of CKD progression on patient-centered outcomes. First, because individuals with mild CKD comprise a much larger proportion of the CKD population, improving our understanding of modifiable risk factors in early disease may have substantial public health implications. Recognizing the need to understand the epidemiology of mild CKD, the parent CRIC Study recently recruited 1500 additional adults with eGFR 45-70 ml/min/1.73m2. However, only 4% of these participants are Hispanic. Second, there is accumulating evidence suggesting that sociocultural and psychosocial factors influence health outcomes in Hispanics but these factors have not been studied in the context of CKD. Third, in addition to studying traditional clinical outcomes, there is growing recognition of the need to study outcomes defined by patients as being important. This application seeks to continue follow-up of the existing Hispanic CRIC cohort and enrich it with recruitment of 125 Hispanics with mild CKD (eGFR 45-70 ml/min/1.73m2) to accomplish the following Aims: 1) Evaluate the association of Hispanic ethnicity with risk of CKD progression and cardiovascular events in adults with mild CKD; 2) Investigate the association of sociocultural and psychosocial factors with CKD progression and cardiovascular events among Hispanics across the spectrum of CKD severity; and 3) Examine the relationship of CKD progression with patient-centered outcomes (e.g., HRQOL, physical function, pain) across the spectrum of CKD severity, among Hispanics and across racial/ethnic groups. The renewal of Hispanic CRIC and its continued close link to the parent CRIC Study provides an unprecedented opportunity to efficiently address a broad range of critical questions regarding the epidemiology of CKD in Hispanics.