Pulse wave velocity in chronic kidney disease

国家糖尿病、消化和肾脏疾病研究所(NIDDK)建立了慢性肾脏 2001年的不充分队列研究。CRIC研究的主要目标是检查慢性疾病的风险因素。 肾病(CKD)进展(即肾功能进一步丧失)和心血管事件 CKD的不同严重程度，并开发预测模型，以识别CKD的高危亚组。后者 结果将针对未来治疗试验的高危受试者进行登记，并增加可用的应用 预防性治疗。高血压治疗已成为改变肾脏病程的最有效干预措施 慢性肾脏病的功能丧失。然而，用于治疗高血压的药物对肾脏的益处是不同的。 功能。这增加了这样一种可能性，即降压本身只能部分解释它们的有益效果 并呼吁人们对CKD等疾病的血管适应有更广泛的理解。脉搏波的测定 反映大血管硬度的血流速度(PWV)在心血管疾病中提供了有用的信息 流行病学。 我们假设脉搏波速度预测慢性肾脏疾病患者的进展，我们 建议以三个具体目标进行测试： 具体目标1：确定慢性肾脏疾病患者的不同队列中的脉搏波速度。 具体目的2：确定脉搏波速度在CKD队列中预测肾功能衰竭进展的有效性。 具体目标3：确定脉搏波速度在CKD队列中预测心血管结局的实用性。 这些目标将在#年在7个临床中心招募的3000人中进行，其中50%为糖尿病患者。 美国从2003年开始，在30个月的时间里招募了人才。从这项研究中得出的所有数据将在#年在宾夕法尼亚大学进行管理 与生物统计和流行病学中心合作。所采用的技术不会对受试者造成风险 以及最小的执行时间负担。该修订的申请提供了关于技术重复性的数据， 扩大了初步数据，纳入了中央增长指数措施，并修订了分析 解决许多重要问题的权力部分，这些问题是由第一次审查中的批评提出的。改进 对慢性肾脏病进展和心血管终点发生的病因的认识将有助于疾病的发展 以及测试干预措施，以减少晚期肾功能衰竭的负担以及心血管发病率和死亡率。

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.