Pulse wave velocity in chronic kidney disease

描述（由申请人提供）： 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研究。CRIC研究的主要目标是检查慢性肾脏病（CKD）进展（即肾功能进一步丧失）和不同严重程度CKD患者心血管事件的风险因素，并开发预测模型，以识别CKD高风险亚组。后者的结果将针对未来治疗试验招募高风险受试者，并增加可用预防疗法的应用。高血压治疗是改变CKD患者肾功能丧失过程的最有效干预措施。然而，用于治疗高血压的药物对肾功能的益处不同。这提出了一种可能性，即血压降低本身只能部分解释其有益效果，并呼吁更广泛地理解血管对CKD等疾病的适应性。脉搏波传导速度（PWV）反映了大血管的硬度，它的测定为心血管疾病的流行病学研究提供了有用的信息。 我们假设脉搏波速度预测慢性肾脏疾病受试者的进展，我们建议用三个具体目标进行测试： 具体目标1： 确定慢性肾脏疾病受试者异质队列的脉搏波速度。 具体目标二： 确定脉搏波传导速度预测CKD队列中肾衰竭进展的效用。 具体目标3： 确定脉搏波传导速度预测CKD队列心血管结局的效用。 这些目标将在3000人的人群中实施，其中50%患有糖尿病，从2003年开始，在美国的7个临床中心招募了30个月。来自本研究的所有数据将在宾夕法尼亚大学与生物统计学和流行病学中心合作管理。所采用的技术对受试者没有风险，并且执行时间负担最小。本修订版申请提供了有关技术再现性的数据、扩展的初步数据、纳入中央增强指数措施的数据，以及修订的分析和功率部分，这些部分解决了第一次审查中提出的许多重要问题。提高对CKD进展和心血管终点发生的病因学因素的认识将允许开发和测试干预措施，以减少晚期肾衰竭和心血管发病率和死亡率的负担。

DESCRIPTION (provided by applicant): The National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) established the Chronic Renal Insufficiency Cohort Study in 2001. The principal goals of the CRIC Study are to examine risk factors for chronic kidney disease (CKD) progression (i.e. further loss of kidney function) and cardiovascular events among patients with varying severity of CKD, and develop predictive models that will identify high-risk subgroups with CKD. The latter results will target enrollment of high-risk subjects into future treatment trials and increase application of available preventive therapies. Hypertension treatment has been the most effective intervention altering the course of renal function loss in CKD. However, the drugs used in the treatment of hypertension differ in their benefits on renal function. This raises the possibility that blood pressure reduction by itself only partly explains their beneficial effect and beckons a broader understanding of vascular adaptation to diseases such as CKD. Determination of the pulse wave velocity (PWV) a reflection of large vessel stiffness has provided useful information in cardiovascular disease epidemiology. We hypothesize that pulse wave velocity predicts progression in subjects with chronic kidney disease, which we propose to test with three specific aims: Specific Aim 1: To determine pulse wave velocity in a heterogeneous cohort of subjects with chronic kidney disease. Specific Aim 2: To determine the utility of pulse wave velocity to predict of renal failure progression in a CKD cohort. Specific Aim 3: To determine the utility of pulse wave velocity to predict cardiovascular outcomes in a CKD cohort. These aims will be carried out in a population of 3000 individuals, 50% with diabetes, recruited at 7 clinical centers in the USA recruited over 30 months beginning in 2003. All data derived from this study will be managed here at Penn in cooperation with the Center for Biostatistics and Epidemiology. The techniques employed involve no risk to subjects and a minimal burden of time to perform. This revised application presents data on technique reproducibility, expanded preliminary data, tile incorporation of central augmentation index measures, and revised analysis & power sections that address tile many important issues raised by the critiques from tile first review. Improved recognition of etiological factors in CKD progression and cardiovascular endpoint occurrence will permit development and testing of interventions to reduce the burden of advanced renal failure and cardiovascular morbidity and mortality.