Acute kidney injury among patients with chronic kidney disease

项目摘要 急性肾损伤（阿基）是肾脏疾病的主要表现之一。阿基的重要性在于 最近的研究报告强调，其发病率正在增加。阿基不成比例地影响那些 慢性肾脏疾病（CKD），因此将阿基的研究嵌入最大和最大的 在美国进行的CKD综合性前瞻性队列研究，慢性肾功能不全队列（CRIC） study. 我们建议全面评估CRIC第3期和第4期所有入组者的所有住院病历 (from 2013-2021年），以确定阿基发作，定义其严重程度并检查其后遗症。审评委是 十几年前，作为CKD自然史的研究而启动。它现在提供了一个未充分利用，但 这是一个潜在的无与伦比的机会，可以促进我们对阿基在塑造自然环境中所起作用的理解。 CKD病史。特别有价值的是研究协议驱动的数据收集的可用性， 住院阿基发作前后的生物标本。 我们的具体目的是：1）评估住院阿基及其严重程度与后续率的关系 考虑AKI前估计的肾小球滤过率（eGFR）斜率后的肾功能丧失， AKI前蛋白尿水平; 2）评估住院阿基及其严重程度与AKI前蛋白尿水平变化的相关性， 蛋白尿，并评估AKI后蛋白尿水平与随后CKD进展之间的关系; 3） 定义与住院阿基相关的未来心血管事件风险及其严重程度; 4） 确定住院阿基与损伤、炎症和 纤维化 与目前文献中发表的基于观察数据的所有其他研究相比，我们的研究将 一个更严格的实验设计，大大减少残余混杂和其他偏见。我们 研究结果可能会挑战目前的统治范式，即轻度至中度阿基发作会使 CKD的病程/结局。

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.