Chronic Renal Insufficiency Cohort Study II

据估计，患有轻度至中度慢性肾功能不全（CRI）的美国人的数量 超过一千万并且还在增长然而，对流行病学、护理和 CRI患者的结局。此外，进展为终末期肾病的预测因子和 CRI对心血管和外周血管疾病风险的影响还不清楚。 我们建议在旧金山和旧金山的Kaiser Permanente之间建立一个联合的弗朗西斯科湾区临床中心。 北方加州和加州大学旧金山分校弗朗西斯科为NIDDK赞助的 3000例轻度至中度CRI患者队列。我们将入组520例受试者：410例来自Kaiser Permanente和来自加州大学旧金山弗朗西斯科的110名受试者以及提供了一个独特的， 来自Kaiser的肾功能保留成人的大型自动匹配队列。的具体目标 这些研究是： 目的1：描述非卧床患者肾功能不全的进展， 肾功能快速恶化的预测因素。 目的2：确定心血管、脑血管和外周血管疾病的风险 事件与肾功能不全的严重程度相关， 在不同的患者亚组中，受“传统”和“新型”血管风险因素的影响。 目的3：评估慢性肾脏病患者获得护理的机会和质量的变化， 社会人口亚组、地理区域和卫生系统之间的不足 及其与临床结局的关系 目的4：评价肾小球滤过率的临床和预后价值 与血清肌酸酐相比，标准化为体表面积，估计或测量 肌酐清除率、估计的肾小球滤过率和测量的绝对肾小球滤过率 不同人口统计学和疾病亚组的滤过率

The number of Americans who suffer from mild-to-moderate chronic renal insufficiency (CRI) is estimated to be over 10 million and growing. However, remarkably little is known about the epidemiology, care, and outcomes of patients with CRI. Furthermore, the predictors of progression to end-stage renal disease and the impact of CRI on the risk of cardiovascular and peripheral vascular disease are not well understood. We propose to establish a joint San Francisco Bay Area Clinical Center between Kaiser Permanente of Northern California and the University of California, San Francisco to contribute to the NIDDK-sponsored cohort of 3000 patients with mild-to-moderate CRI. We will enroll 520 subjects: 410 from Kaiser Permanente and 110 subjects from the University of California, San Francisco as well as provide a unique, large automated matched cohort of adults from Kaiser with preserved renal function. The specific aims of the study are: Aim 1: To characterize the progression of renal insufficiency in ambulatory patients and to identify predictors of rapid deterioration of renal function. Aim 2: To determine how the risk of cardiovascular, cerebrovascular, and peripheral vascular events is associated with the severity of renal insufficiency and how its relationship is affected by "traditional" and "novel" vascular risk factors in different patient subgroups. Aim 3: To assess the variation in the access and quality of care for patients with chronic renal insufficiency across sociodemographic subgroups, geographic areas, and health systems and its association with clinical outcomes Aim 4: To evaluate the clinical and prognostic utility of measured glomerular filtration rate normalized to body surface area compared to serum creatinine, estimated or measured creatinine clearance, estimated glomerular filtration rate and measured absolute glomerular filtration rate across different demographic and disease subgroups