A Triple Marker Approach To Optimize CKD Detection Among Black and White Adults

优化黑人和白人成人 CKD 检测的三重标记方法

• 批准号: 8351054
• 负责人: Carmen Alicia Peralta
• 金额: $ 18.53万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8351054
• 关键词: Adult; Affect; Age; Aging; Albumins; Albuminuria; Atherosclerosis; Body Composition; Cardiovascular system; Cessation of life; Characteristics; Chronic Disease; Chronic Kidney Failure; Clinical; Computerized Medical Record; Consensus; Coronary artery; Creatinine; Data; Detection; Development; Diabetes Mellitus; Diagnosis; Early Diagnosis; Early treatment; Elderly; End stage renal failure; Epidemiology; Equation; Ethnic Origin; Ethnic group; Evaluation; Event; Filtration; Funding; General Practices; Glomerular Filtration Rate; Goals; Grant; Guidelines; Health; Health Surveys; Heart failure; High Prevalence; Hypertension; Individual; Injury; Investigation; Kidney; Kidney Diseases; Knowledge; Label; Laboratories; Lead; Measures; Meta-Analysis; Morbidity - disease rate; National Health and Nutrition Examination Survey; Nephrology; Nutrition Surveys; Obesity; Persons; Population Heterogeneity; Prevalence; Prevention; Prevention program; Prevention strategy; Probability; Race; Relative (related person); Renal function; Reporting; Research; Resources; Risk; Risk Factors; Screening procedure; Serum; Stratification; Stroke; Testing; United States National Institutes of Health; Urine; Work; aged; base; clinical practice; cohort; design; diabetic; disorder prevention; disorder risk; ethnic minority population; high risk; impaired glucose tolerance; improved; muscle form; non-diabetic; post gamma-globulins; programs; racial difference; sex; tool; young adult

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is highly morbid, and it affects race/ethnic minorities disproportionately. Early detection and treatment are the cornerstones of prevention epidemiology. Yet to date, there is no consensus for CKD screening among persons without diabetes. The current clinical strategy among non-diabetics relies on serum creatinine for diagnosing CKD, and this strategy misses many persons at risk. In fact, 1 in 6 adults in the U.S. may have undetected CKD despite having creatinine measured. Serum creatinine is biased by age and race, which results in the inability to reliably detect CKD across age and race/ethnic groups. Despite the availability of an established marker of kidney injury such as albumin-to-creatinine ratio (ACR) and an alternative filtration marker, cystatin C, these are not routinely recommended or used in general clinical practice. These markers have been shown to improve CKD risk stratification, but their utility in CKD screening is not known. ACR and cystatin C can detect CKD that is missed by creatinine (occult CKD) in up to 16% of U.S. adults. Persons with occult CKD are at high risk for death, cardiovascular events and progression to ESRD. The use of a triple marker approach of creatinine, cystatin C, and ACR to detect CKD has not been studied. Moreover, the absence of evidence to determine who would benefit most from CKD screening prohibits investigation of targeted screening programs. Without effective screening programs, our ability to detect CKD and to design and evaluate prevention strategies is limited. This application proposes a paradigm shift in the field of CKD prevention by developing the knowledge necessary to design, evaluate and implement effective CKD screening strategies across diverse populations. Specifically, we propose to pool data from four large, ongoing, NIH-funded cohorts that represent over 27,000 Black and White persons aged 28-84: the Coronary Artery Risk Development in Young Adults (CARDIA), Multi-Ethnic Study of Atherosclerosis (MESA), Reasons for Geographical and Racial Differences in Stroke (REGARDS), and the Health, Aging and Body Composition (Health ABC) Studies. We propose to use these pooled data to implement a triple marker approach to investigate the prevalence of occult CKD among non-diabetics. We will evaluate the numbers needed to screen to detect occult CKD by cystatin C or ACR. Our second goal is to evaluate risk factors associated with occult CKD overall and by age, sex and race/ethnicity. We will then develop a prediction tool for occult CKD and a clinician-friendly, online calculator to estimate an individual's probability of having occult CKD. The data generated from these projects can directly lead to the evaluation of screening strategies that are targeted to individual risk. PUBLIC HEALTH RELEVANCE: Early detection of CKD may improve our ability to implement prevention programs, yet there is no consensus regarding CKD screening among adults without diabetes. The current strategy for detecting kidney disease in non-diabetics is narrowly focused, and misses a large proportion of affected individuals. This proposal envisions the use of three markers to detect kidney disease in persons deemed to be at high risk for having CKD that may be missed by current clinical practice. The knowledge gained from this proposal could change the way we screen for CKD and allow implementation of prevention strategies.

描述（由申请人提供）：慢性肾脏病（CKD）是一种高度病态的疾病，对种族/少数民族的影响不成比例。早期发现和治疗是预防流行病学的基石。然而，迄今为止，在无糖尿病的人群中没有CKD筛查的共识。目前非糖尿病患者的临床策略依赖于血清肌酐来诊断CKD，这种策略错过了许多有风险的人。事实上，美国每6名成年人中就有1人可能患有未检测到的CKD，尽管他们测量了肌酐。血清肌酐因年龄和种族而存在偏倚，导致无法可靠地检测不同年龄和种族/民族的CKD。尽管存在肾损伤的既定标志物，如白蛋白-肌酐比（ACR）和替代滤过标志物胱抑素C，但在一般临床实践中并不推荐或使用。这些标志物已被证明可以改善CKD风险分层，但其在CKD筛查中的效用尚不清楚。ACR和半胱氨酸蛋白酶抑制剂C可以检测到高达16%的美国成年人中被肌酐遗漏的CKD（隐匿性CKD）。隐匿性CKD患者死亡、心血管事件和进展为ESRD的风险较高。尚未研究使用肌酸酐、半胱氨酸蛋白酶抑制剂C和ACR三重标志物方法来检测CKD。此外，缺乏证据来确定谁将从CKD筛查中受益最大，这阻碍了有针对性的筛查计划的调查。如果没有有效的筛查计划，我们检测CKD以及设计和评估预防策略的能力是有限的。该申请提出了CKD预防领域的范式转变，通过开发在不同人群中设计，评估和实施有效CKD筛查策略所需的知识。具体来说，我们建议汇总来自四个大型的、正在进行的、NIH资助的队列的数据，这些队列代表了27，000多名28-84岁的黑人和白色人：年轻人冠状动脉风险发展（CARDIA）、动脉粥样硬化的多种族研究（梅萨）、中风的地理和种族差异原因（REGARDS）以及健康、衰老和身体成分（健康ABC）研究。我们建议使用这些汇总数据来实施一种三重标记方法，以调查非糖尿病患者中隐匿性CKD的患病率。我们将评估通过半胱氨酸蛋白酶抑制剂C或ACR筛查检测隐匿性CKD所需的人数。我们的第二个目标是评估与隐性CKD相关的风险因素，包括年龄、性别和种族。然后，我们将开发一个隐匿性CKD的预测工具和一个临床医生友好的在线计算器，以估计个人的隐匿性CKD的概率。从这些项目中产生的数据可以直接导致针对个人风险的筛选策略的评估。 公共卫生关系：CKD的早期检测可能会提高我们实施预防计划的能力，但在无糖尿病的成人中进行CKD筛查尚未达成共识。目前在非糖尿病患者中检测肾脏疾病的策略是狭隘的，并且错过了很大一部分受影响的个体。该提案设想使用三种标志物来检测被认为具有CKD高风险的人的肾脏疾病，这些人可能被当前的临床实践所遗漏。从这项建议中获得的知识可以改变我们筛查CKD的方式，并允许实施预防策略。