Chronic Kidney Disease in Children (CKiD)

描述(由申请人提供)： 慢性肾脏疾病(CKD)及其代谢紊乱严重影响儿童的健康。为了明确进行性慢性肾脏病不良反应的性质、程度和时间演变，我们建议对儿童慢性肾脏病进行前瞻性研究，以确定(1)肾功能加速衰退的危险因素；(2)脑功能和结构受损的发生率、性质、程度和时间演变；(3)心血管疾病(CVD)危险因素的患病率；以及(4)生长衰竭及其治疗对发病率的影响。儿童慢性肾脏疾病前瞻性研究(C-Kid)是一项对600名19岁儿童进行的纵向观察性研究，这些儿童的肾功能轻度到中度受损(估计肾小球滤过率(GFR)为30-75ml/min/1.73m2)。随访期为2.5至4.5年。在登记时以及之后的年度访问中，将使用标准化问卷获得参与者的选定暴露，包括社会人口学特征、家族史、卫生保健利用、环境暴露和药物使用。还将测量标准化血压、生长和营养评估、代谢状态、贫血、血脂异常、微炎症、胰岛素抵抗和蛋白尿的指标。肾功能(GFR)水平将每年通过血浆碘己醇消失来测量。令人感兴趣的主要结果将是与CKD进展相关的亚临床措施和临床事件的时间演变，通过GFR下降、生长障碍及其治疗、神经认知和行为缺陷以及心血管疾病来衡量，这些在我们下面的目标中有具体规定。可利用C-Kid基础设施进行的潜在分析，以探讨风险因素与疾病的关系，包括传统的前瞻性队列分析，其中假定的风险因素是在基线时对参与者进行测量的；嵌套病例对照研究，其中对病例(例如快速进展者)和适当匹配的对照(例如非进展者)中储存的基线样本进行实验室研究；以及利用平行队列进行交叉队列分析。

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) and its metabolic derangements substantially affect the well-being of children. In order to define the nature, magnitude, and temporal evolution of the adverse effects of progressive CKD, we propose to conduct a prospective study of CKD in children to determine (1) risk factors for accelerated decline in renal function; (2) incidence, nature, magnitude and temporal evolution of impaired brain function and structure; (3) prevalence of risk factors for cardiovascular disease (CVD); and (4) implications of growth failure and its treatment on morbidity. ]'he Prospective Study of Chronic Kidney Disease in Children (C-Kid) is a longitudinal, observational study of 600 children, aged < 19 yrs with mildly to moderately impaired kidney function (estimated glomerular filtration rate (GFR) 30-75 ml/min/1.73m2). The follow-up period will be 2.5 to 4.5 years. At enrollment, and at annual visits thereafter, selected exposures will be obtained on participants, including sociodemographic characteristics, family history, health care utilization, environmental exposures and medication use using standardized questionnaires. Standardized blood pressure, growth and nutritional assessments, metabolic status, measures of anemia, dyslipidemia, measures of microinflammation, insulin resistance and proteinuria will also be measured. Level of kidney function (GFR) will be measured annually by plasma disappearance of iohexol. The primary outcomes of interest will be the temporal evolution of subclinical measures and clinical events associated with CKD progression as measured by decline in GFR, growth failure and its treatment, neurocognitive and behavioral deficits and cardiovascular disease, specified in our aims below. Potential analyses that could be conducted using the C-Kid infrastructure to explore risk-factor disease relationships include traditional prospective cohort analyses where putative risk factors are measured in participants at baseline; nested case-control studies in which laboratory studies are performed on stored baseline specimens in cases (e.g. rapid progressors) and appropriately matched controls (e.g. non-progressors); and cross-cohort analyses utilizing parallel cohorts.