Retinopathy in Chronic Renal Insufficiency

描述（由申请人提供）：慢性肾功能不全（CRI）已被认为是一种无声的流行病，影响着1000多万美国人。为了了解进行性肾脏疾病和心血管疾病之间的关系，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研究的主要目标是检查不同严重程度CRI患者中CRI和CVD事件的风险因素，并开发预测模型，以识别CRI高风险亚组。CRIC研究未将眼部部分作为患者总体评估的一部分。然而，最近的研究表明，由于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其他器官（如肾脏和心脏）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进展的风险显著增加相关。为了获得关于CRIC人群中眼部病理学的信息，我们获得了1890名CRIC受试者的一组基线眼底照片。这项随访辅助研究的目的是获得具有可分级基线照片的CRIC患者的3年随访眼底照片，以研究视网膜病变进展与CRI和CVD进展之间的关系。潜在地，非侵入性眼底摄影可以提供关于微血管的独特信息，这将无法通过任何其他手段获得。这种信息可以查明新的风险因素，从而大大改进审评委研究报告所拟建立的预测模型。此外，由于许多CRIC研究参与者因糖尿病、全身性高血压和其他血管疾病而发生视网膜病变的高风险，因此评估CRI患者的眼部状况以获得对CRI引起的整体病理学的更全面评价是很重要的。这项资助提供了一个独特的机会，将CRIC患者的眼部状况信息与CRIC研究将收集的大量数据合并，这一奋进将对视网膜病变和CRI之间的关系产生重要的见解。 公共卫生相关性：我们目前正在进行一项由NIDDK资助的研究，其中已在参与慢性肾功能不全队列（CRIC）研究的肾病患者中获得基线照片。在当前的补充或修订申请中，我们建议在我们之前获得基线照片的患者中获得额外的3年随访眼部照片。这将使我们能够研究视网膜病变进展与肾脏和心脏疾病进展之间的关系。由于眼睛后部血管中发生的病理变化可能代表身体其他部位发生的血管变化，因此通过非侵入性摄影获得的数据可以提供有关肾脏和心脏疾病进展的重要预后信息。

DESCRIPTION (provided by applicant): Chronic Renal Insufficiency (CRI) has been 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. To gain information about eye pathology in the CRIC population we obtained a set of baseline fundus photographs in 1890 CRIC subjects. The purpose of this follow up ancillary study will be to obtain 3-year follow up fundus photographs on CRIC patients that have gradable baseline photographs, to investigate the relationship between progression of retinopathy and progression of CRI and CVD. 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. PUBLIC HEALTH RELEVANCE: We are currently performing a study funded by the NIDDK in which photographs have been obtained at baseline in patients with kidney disease that are participating in the Chronic Renal Insufficiency Cohort (CRIC) study. In this current Supplemental or Revised application, we are proposing to obtain additional 3-year follow up eye photography in patients in which we have previously obtained baseline photos. This will allow us to investigate the relationship between progression of retinopathy and progression of kidney and cardiac disease. Because the pathologic changes that occur in the blood vessels in the back of the eye probably represent vascular changes that occur in the rest of the body, the data obtained through non-invasive photography may provide important information of prognostic value regarding the progression of kidney and heart disease.