Acute kidney injury among patients with chronic kidney disease

慢性肾脏病患者的急性肾损伤

• 批准号: 9978765
• 负责人: Chi-yuan Hsu
• 金额: $ 67.97万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978765
• 关键词: Accounting; Acute Renal Failure with Renal Papillary Necrosis; Address; Adult; Affect; Biological Markers; CCL2 gene; CHI3L1 gene; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chitinase; Chronic Kidney Failure; Chronic Kidney Insufficiency; Code; Cohort Studies; Conflict (Psychology); Creatinine; Data; Data Analyses; Data Collection; Diagnostic; Disease Progression; Event; Experimental Designs; Fibrosis; Future; Glomerular Filtration Rate; Hospital Records; Hospitalization; Human; Incidence; Inflammation; Injury; Inpatients; Interleukin-18; Investigation; Kidney Diseases; Knowledge; Literature; Longitudinal Studies; Measurement; Muscular Atrophy; Natural History; Outcome; Patient-Focused Outcomes; Patients; Performance; Phase; Phenotype; Plasma; Play; Population Heterogeneity; Prospective cohort; Prospective cohort study; Proteins; Proteinuria; Protocols documentation; Publishing; Renal function; Reporting; Research; Residual state; Risk; Risk Factors; Role; Serum; Severities; Shapes; Urine; base; cardiovascular risk factor; clinical care; cohort; cost; follow-up; high risk; improved outcome; interest; muscle form; post gamma-globulins; prospective; rat KIM-1 protein; repaired; secondary analysis

PROJECT SUMMARY Acute kidney injury (AKI) is one of the major manifestations of kidney disease. AKI's importance is underscored by recent studies reporting that its incidence is increasing. AKI disproportionately affects those with chronic kidney disease (CKD), so it is compelling to embed the investigation of AKI in the largest and most comprehensive prospective cohort study of CKD in the US, the Chronic Renal Insufficiency Cohort (CRIC) study. We propose to comprehensively evaluate all inpatient hospital records for all enrollees in CRIC Phases 3 and 4 (from 2013-2021) to identify episodes AKI, define their severity and examine their sequelae. CRIC was launched over a dozen years ago as a study of the natural history of CKD. It now offers an under-utilized but potentially unmatched opportunity to advance our understanding of the role AKI plays in shaping the natural history of CKD. Particularly valuable is the availability of research protocol-driven collection of data and biospecimens both before and after episodes of hospitalized AKI. Our Specific Aims are: 1) to evaluate the associations of hospitalized AKI and its severity with subsequent rate of loss of renal function after taking into account pre-AKI estimated glomerular filtration rate (eGFR) slope and pre-AKI proteinuria level; 2) to evaluate the associations of hospitalized AKI and its severity with change in proteinuria and to assess the relation between post-AKI proteinuria level and subsequent CKD progression; 3) to define the risk of future cardiovascular events associated with hospitalized AKI and its severity; 4) to determine the association of hospitalized AKI with changes in levels of biomarkers of injury, inflammation and fibrosis. Compared with all the other studies based on observational data now published in the literature, ours will have a much more rigorous experimental design, greatly reducing residual confounding and other biases. Our findings may challenge the current reigning paradigm that mild to moderate episodes of AKI worsen the course/outcome of CKD.

项目摘要 急性肾脏损伤（AKI）是肾脏疾病的主要表现之一。 Aki的重要性是 最近的研究强调了其发病率正在增加。 Aki不成比例地影响那些 有慢性肾脏疾病（CKD），因此将AKI的研究嵌入最大，最大，最大的 美国CKD的全面前瞻性队列研究，慢性肾功能不全队列（CRIC） 学习。 我们建议全面评估CRIC阶段所有参与者的所有住院医院记录3和4 （从2013-2021开始）识别情节AKI，定义其严重程度并检查其后遗症。克里克是 作为对CKD的自然历史的研究，启动了十多年。现在它提供了未充分利用的但 潜在的无与伦比的机会，可以促进我们对AKI在塑造自然作用的作用的理解 CKD的历史。特别有价值的是研究协议驱动的数据收集的可用性和 在住院的AKI发作之前和之后，生物测量。 我们的具体目的是：1）评估住院AKI的关联及其与随后的比率 肾功能丧失后，AKI估计的肾小球滤过率（EGFR）斜率和 阿基前蛋白尿水平； 2）评估住院AKI的关联及其与变化的严重性 蛋白尿并评估蛋白尿后蛋白尿水平与随后的CKD进展之间的关系； 3） 定义与住院AKI及其严重性相关的未来心血管事件的风险； 4）到 确定住院的AKI与伤害，炎症和 纤维化。 与现在在文献中发表的观察数据的所有其他研究相比，我们的研究 更严格的实验设计，大大减少了残留混杂和其他偏见。我们的 调查结果可能会挑战当前的统治范式，即Aki的轻度至中度发作使 CKD的课程/结果。