Acute kidney injury among patients with chronic kidney disease

项目总结 急性肾损伤(AKI)是肾脏疾病的主要表现之一。Aki的重要性在于 最近的研究表明，它的发病率正在增加。Aki不成比例地影响了那些 由于慢性肾脏病(CKD)，因此迫切需要将AKI的调查嵌入到最大和最 美国慢性肾功能不全患者的综合性前瞻性队列研究(CRIC) 学习。 我们建议对CRIC第三和第四阶段的所有参与者的所有住院记录进行综合评估 (2013-2021年)确定AKI发作，定义其严重性并检查其后遗症。CRIC是 十多年前推出，作为对CKD自然历史的研究。它现在提供了一个未充分利用的 潜在的无与伦比的机会，以促进我们对AKI在塑造自然 CKD的历史。特别有价值的是研究协议驱动的数据收集和 AKI住院前后的生化指标。 我们的具体目标是：1)评估住院AKI及其严重程度与复发率的关系 考虑AKI前估计的肾小球滤过率(EGFR)斜率和 AKI前蛋白尿水平；2)评估住院AKI及其严重程度与 并评估AKI后蛋白尿水平与CKD进展的关系；3) 确定与住院AKI相关的未来心血管事件的风险及其严重性；4) 确定住院AKI与损伤、炎症和生物标志物水平变化的相关性 纤维化症。 与现在文献中公布的所有其他基于观测数据的研究相比，我们的研究将具有 更严谨的实验设计，大大减少了残留混杂和其他偏差。我们的 研究结果可能会挑战目前的主导范式，即轻到中度的急性心肌梗死发作会使病情恶化 慢性肾脏病的病程/转归。

PROJECT SUMMARY Acute kidney injury (AKI) is one of the major manifestations of kidney disease. AKI's importance is underscored by recent studies reporting that its incidence is increasing. AKI disproportionately affects those with chronic kidney disease (CKD), so it is compelling to embed the investigation of AKI in the largest and most comprehensive prospective cohort study of CKD in the US, the Chronic Renal Insufficiency Cohort (CRIC) study. We propose to comprehensively evaluate all inpatient hospital records for all enrollees in CRIC Phases 3 and 4 (from 2013-2021) to identify episodes AKI, define their severity and examine their sequelae. CRIC was launched over a dozen years ago as a study of the natural history of CKD. It now offers an under-utilized but potentially unmatched opportunity to advance our understanding of the role AKI plays in shaping the natural history of CKD. Particularly valuable is the availability of research protocol-driven collection of data and biospecimens both before and after episodes of hospitalized AKI. Our Specific Aims are: 1) to evaluate the associations of hospitalized AKI and its severity with subsequent rate of loss of renal function after taking into account pre-AKI estimated glomerular filtration rate (eGFR) slope and pre-AKI proteinuria level; 2) to evaluate the associations of hospitalized AKI and its severity with change in proteinuria and to assess the relation between post-AKI proteinuria level and subsequent CKD progression; 3) to define the risk of future cardiovascular events associated with hospitalized AKI and its severity; 4) to determine the association of hospitalized AKI with changes in levels of biomarkers of injury, inflammation and fibrosis. Compared with all the other studies based on observational data now published in the literature, ours will have a much more rigorous experimental design, greatly reducing residual confounding and other biases. Our findings may challenge the current reigning paradigm that mild to moderate episodes of AKI worsen the course/outcome of CKD.