Role of pre-ESRD blood pressure management on post-ESRD outcomes

描述（由申请人提供）：尽管慢性肾脏疾病（CKD）是终末期肾脏疾病（ESRD）的先兆，但很少有ESRD后结局的研究捕获了CKD期间发生的事件的信息。因此，基本和重要的问题仍未得到解答。例如，CKD阶段的干预措施如何影响ESRD阶段的结果？本研究的主要目的是了解慢性肾病期间血压控制的严密性是否以及如何影响ESRD患者的死亡风险。为了实现这一点，我们将研究两项已完成的nih赞助的随机对照试验的入组者：肾脏疾病饮食改变（MDRD）研究和非裔美国人肾脏疾病和高血压研究（AASK）。MDRD和AASK都在CKD阶段招募了患者，但许多参与者继续发展为ESRD，他们的ESRD后结果可以通过美国肾脏疾病系统（USRDS）进行跟踪，这是一个全国性的ESRD综合登记处。我们的研究方法和研究设计为研究CKD阶段的其他治疗选择如何影响ESRD后的结果提供了机会。通过将USRDS与MDRD和AASK联系起来，我们将对导致ESRD患者不良结局高发生率的可改变风险因素有新的认识。我们的研究结果可能会为CKD患者应该如何严格控制血压的争论提供信息，并指导肾脏疾病患者的营养管理和其他方面的护理。

DESCRIPTION (provided by applicant): Although chronic kidney disease (CKD) is the precursor to end-stage renal disease (ESRD), few studies of outcomes after ESRD have captured information about events that occurred during CKD. Basic and important questions therefore remain unanswered. For example, how do interventions during the CKD phase of disease affect outcomes at the ESRD phase of disease? The major goal in this study is to understand whether and how mortality risk among ESRD patients is affected by tightness of blood pressure control during CKD. To achieve this, we will study enrollees of two completed NIH-sponsored randomized controlled trials: the Modification of Diet in Renal Disease (MDRD) study and the African American Study of Kidney Disease and Hypertension (AASK). Both MDRD and AASK enrolled patients during the CKD phase of disease, but numerous participants went on to develop ESRD and their post- ESRD outcomes can be tracked via United States Renal Disease System (USRDS), the nationally comprehensive ESRD registry. Our research approach and study design lends opportunities to examine how other therapeutic choices during the CKD phase of disease will affect outcomes after ESRD. By linking USRDS with MDRD and AASK, we will gain new insight into modifiable risk factors contributing to the high rates of adverse outcomes among patients with ESRD. Our results may inform the debate about how tightly blood pressure should be managed among CKD patients as well as guide nutrition management and other aspects of care in kidney disease patients.