CRIC-Plus: Study of Advanced Chronic Renal Insufficiency

CRIC-Plus：晚期慢性肾功能不全的研究

• 批准号: 7388282
• 负责人: Chi-yuan Hsu
• 金额: $ 88.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7388282
• 关键词: Adult; Affect; Anemia; Cardiovascular Diseases; Cessation of life; Chronic Kidney Insufficiency; Clinical; Cohort Studies; Complement; Condition; Dialysis procedure; Echocardiography; End stage renal failure; Event; Frequencies; Functional disorder; Glomerular Filtration Rate; Goals; Hospitalization; Individual; Inflammation; Intervention; Knowledge; Left ventricular structure; Malnutrition; Measures; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Patients; Physical Dialysis; Proteinuria; Protocols documentation; Renal function; Research Personnel; Risk; Time; Ventricular; cardiovascular risk factor; cohort; falls; follow-up

Although chronic renal insufficiency is the precursor to end-stage renal disease, few studies have examined the critical transition from advanced chronic renal insufficiency to end-stage renal disease. Basic and important questions, therefore, remain unanswered. For example: which patients with advanced chronic renal insufficiency are most likely to develop end-stage renal disease? How does cardiovascular disease evolve during the transition from advanced chronic renal insufficiency to end-stage renal disease? Howdo events and interventions during chronic renal insufficiency affect outcomes after onset of end-stage renal disease? The NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) study, which tracks a large cohort of individuals with chronic renal insufficiency, presents a unique opportunity to fill this important gap in knowledge. In this application, entitled "CRIC-Plus," we propose to intensify the study of patients who develop advanced chronic renal insufficiency and end-stage renal disease. Specifically, for patients whose glomerular filtration rate falls below 20 ml/min/1.73m2, renal function will be assessed every six months, additional echocardiograms at key clinical milestones will be performed and end-stage renal disease related parameters will be recorded. Our specific aims complement and substantially extend the core aims of CRIC. Aim #1: To determine the frequency of progression to end-stage renal disease compared with death from competing causes among patients with glomerular filtration rate below 20 ml/min/1.73m2 and to identify predictors of these different outcomes. Aim #2: To compare left ventricular structure and function when glomerular filtration rate falls below 20 ml/min/1.73m2 with left ventricular structure and function at the onset of end-stage renal disease. Aim #3: To compare predicted risks of cardiovascularevents, hospitalization and death using exposures measured when glomerular filtration rate falls below 20 ml/min/1.73m2 with predicted risks using exposures measured at the onset of end-stage renal disease. Aim #4: To study the effect of chronic renal insufficiency management, including the timing of dialysis initiation, on clinical outcomes after onset of end-stage renal disease.

尽管慢性肾功能不全是终末期肾病的先兆，但很少有研究探讨 从晚期慢性肾功能不全到终末期肾病的关键转变。基本和 因此，一些重要问题仍未得到解答。例如：哪些晚期慢性病患者 肾功能不全最容易发展为终末期肾病？心血管疾病是如何发生的 从晚期慢性肾功能不全到终末期肾病的转变过程中会发生什么变化？豪多 慢性肾功能不全期间的事件和干预措施会影响终末期肾功能不全发作后的结局 疾病？ NIDDK 赞助的慢性肾功能不全队列 (CRIC) 研究追踪了大量的 患有慢性肾功能不全的个体，提供了一个独特的机会来填补这一重要的空白 知识。在这份题为“CRIC-Plus”的申请中，我们建议加强对以下患者的研究： 发展为晚期慢性肾功能不全和终末期肾病。具体而言，对于以下患者 肾小球滤过率低于20ml/min/1.73m2，每六个月评估一次肾功能， 将在关键临床里程碑进行额外的超声心动图检查，并与终末期肾病相关 参数将被记录。我们的具体目标补充并实质上扩展了 CRIC 的核心目标。 目标#1：确定进展为终末期肾病的频率与死亡的频率相比 肾小球滤过率低于 20 ml/min/1.73m2 的患者之间的竞争原因，并确定 这些不同结果的预测因素。 目标#2：比较肾小球滤过率低于 20 时的左心室结构和功能 ml/min/1.73m2 与终末期肾病发作时的左心室结构和功能。 目标#3：使用暴露比较心血管事件、住院和死亡的预测风险 当肾小球滤过率低于 20 ml/min/1.73m2 时进行测量，并使用暴露预测风险 在终末期肾病发作时测量。 目标#4：研究慢性肾功能不全管理的效果，包括透析的时机 启动，对终末期肾病发作后的临床结果。