Retinopathy in Chronic Renal Insufficiency

描述(申请人提供)：慢性肾功能不全(CRI)最近被认为是一种影响1000多万美国人的无声流行病。为了了解进行性肾脏疾病和心血管疾病之间的关系，美国国家糖尿病、消化和肾脏疾病研究所(NIDDK)于2001年建立了慢性肾功能不全队列(CRIC)研究。CRIC研究的主要目标是在不同严重程度的CRI患者中检查CRI和CVD事件的风险因素，并开发预测模型，以确定CRI的高危亚组。CRIC的研究没有将眼睛部分作为患者整体评估的一部分。然而，最近的研究表明，糖尿病和高血压视网膜病变引起的视网膜血管异常是影响肾脏和心脏等其他器官的微血管病变的代表。这种视网膜血管异常的存在与肾脏和心血管疾病等进展的风险显著增加有关。这项辅助研究的目的将是获得CRIC患者的眼底照片，以调查CRI受试者中视网膜病变与CRI和CVD的关系。此外，我们还将评估眼底病理学是否能为肾脏和心血管疾病的进展提供有预后价值的信息。潜在地，非侵入性眼底照相可以提供关于微血管系统的独特信息，这是任何其他方法都无法获得的。这些信息可以确定新的风险因素，这些因素将大大改进将通过审评委研究开发的预测模型。此外，由于CRIC研究的许多参与者都有因糖尿病、全身性高血压和其他血管疾病引起的视网膜病变而发生严重并发症的高风险，因此评估CRI患者的眼睛状况以更全面地评估CRI引起的整体病理是很重要的。这笔赠款提供了一个独特的机会，将关于CRIC患者眼睛状况的信息与CRIC研究将收集的大量数据合并，这一努力将对视网膜病变和CRI之间的关系产生重要的洞察。

DESCRIPTION (provided by applicant): Chronic Renal Insufficiency (CRI) recently was recognized as a silent epidemic affecting more than 10 million Americans. To gain understanding of the relationship between progressive renal disease and cardiovascular illness, the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) established the Chronic Renal Insufficiency Cohort (CRIC) Study in 2001. The principal goals of the CRIC Study are to examine risk factors for CRI and CVD events among patients with varying severity of CRI, and develop predictive models that will identify high-risk subgroups with CRI. The CRIC study did not include an eye component as part of the overall assessment of the patients. Recent studies, however, have suggested that retinal vascular abnormalities due to diabetic and hypertensive retinopathy are representative of the microvascular pathology that affects other organs such as the kidney and the heart. The presence of such retinal vascular abnormalities is associated with a markedly increased risk of progression of renal and cardiovascular disease, among others. The purpose of this ancillary study will be to obtain fundus photographs on CRIC patients to investigate the relationship between retinopathy and CRI and CVD within a population of subjects with CRI. In addition, we will assess whether fundus pathology can provide information of prognostic value regarding the progression of renal and cardiovascular disease. Potentially, non-invasive fundus photography could provide unique information about the microvasculature that would not be available through any other means. Such information could identify new risk factors that would significantly improve the predictive models to be developed through the CRIC study. Additionally, because many of the CRIC study participants are at high risk of developing significant morbidity from retinopathy due to diabetes mellitus, systemic hypertension and other vascular diseases, it is important to assess the ocular condition of patients with CRI to gain a more comprehensive evaluation of the overall pathology caused by CRI. This grant offers a unique opportunity to merge information on the ocular condition of CRIC patients with the vast amount of data that will be collected by the CRIC study, an endeavor that will yield important insight into the relationship between retinopathy and CRI.