Physical Function in Chronic Kidney Disease: Characterizing the Natural History and Relationship to Clinical Outcomes

项目摘要 功能状态的定义是执行独立生活和生活所必需的日常体力任务的能力 对于慢性肾脏疾病(CKD)患者来说，对于疾病自我管理、儿童- Ney移植，并保证良好的生活质量。所有阶段的慢性肾脏病患者都有更高的风险 比一般人更早发生的身体机能不良。由于PHY的高流行率- 慢性肾脏病患者的临床损害，国家肾脏基金会临床实践指南记录- 改进定期评估，以确定那些身体有局限性的人，以改善结果为目标。去- 尽管人们认识到身体机能对慢性肾脏病患者健康的重要性，但有 在慢性肾脏病的背景下，允许进行循证临床监测的研究有限。到目前为止，种马- 肾脏疾病人群中的IES受到在某个时间点进行身体功能检查的限制，受到评估的限制。 仅与死亡率有关，并主要关注肾功能衰竭患者的替代治疗 治疗(KFRT)和老年人。及早发现和干预，预防身体缺陷和残疾 如果在慢性肾脏病的早期阶段和年轻人中实施，可能是最有效的。的风险因素 CKD患者的身体功能下降也没有得到充分的评估，并建议 在CKD护理中，身体功能评估不是常规的。我们打算用近20年的时间 NIDDK赞助的慢性肾功能不全队列(CRIC)研究的后续数据代表 CKD不同阶段的不同人群，以加强我们对预后的理解。 慢性肾脏病患者随时间推移身体功能的重要性，包括对身体危险因素的洞察 功能减退，并构建临床体能监测工具。我们将描述这些轨迹 对慢性肾脏病患者的身体机能及其相关因素的了解 在导致身体机能下降和确定可修改的干预因素的途径中，开发了- 项目(目标1)。我们将确定纵向身体功能与KFRT发病、住院时间的关系。 和死亡(目标2)。最后，我们开发了一个可以指导治疗的身体功能监测工具 以及CKD临床实践中的预后决定。我们还将在外部队列中测试此工具， CKD(目标3)。最终，这项拟议的研究将增加我们对CKD的物理功能的了解，在- 包括对导致下降的风险因素的洞察，以及它与重要结果的关系；这项工作将精炼出… Nate在一套简明的身体机能测量中，可以用于临床监测物理 健康为治疗和预后决定提供信息。这一信息可能会改变慢性肾脏病患者的 监测临床护理，指导以患者为中心的治疗，促进身体功能的广泛改善 通过促进提高认识和有针对性的干预，为这一高危人群提供更好的卫生保健服务。

Project Summary Functional status is defined by the ability to perform daily physical tasks necessary for independent living and is essential among persons with chronic kidney disease (CKD) for disease self-management, eligibility for kid- ney transplantation, and for ensuring good quality of life. People with CKD at all stages are at increased risk of poor physical functioning that occurs earlier than in the general population. Due to the high prevalence of phys- ical impairments among persons with CKD, the National Kidney Foundation clinical practice guidelines recom- mend regular assessments to identify those with physical limitations with the goal of improving outcomes. De- spite this acknowledgement of the importance of physical function to the health of persons with CKD, there has been limited research in the setting of CKD that would allow evidence-based clinical monitoring. To date, stud- ies in kidney disease populations have been limited by examining physical function at one time point, by evalu- ating relationships only with mortality, and by focusing largely on persons with kidney failure with replacement therapy (KFRT) and older adults. Early detection and intervention to prevent physical limitations and disability may be most effective if implemented during earlier stages of CKD and among younger adults. Risk factors of physical function decline have also been inadequately evaluated in persons with CKD and recommended physical function assessments are not routinely performed in CKD care. We propose to use nearly 20 years of follow up data from the NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) Study that represents diverse populations across the spectrum of CKD stages to enhance our understanding of the prognostic im- portance of physical function over time among persons with CKD, including insights to risk factors of physical function decline, and to build a clinical monitoring tool of physical function. We will characterize the trajectories of physical function along with their associated factors among people with CKD to increase the understanding of the pathways that lead to physical function decline and to identify modifiable factors for intervention develop- ment (Aim 1). We will determine the relationship of longitudinal physical function with onset of KFRT, hospitali- zations, and death (Aim 2). Lastly, we develop a monitoring tool for physical function that could guide treatment and prognostic decisions in CKD clinical practice. We will also test this tool in an external cohort with advanced CKD (Aim 3). Ultimately, the proposed study will increase our understanding of physical function in CKD, in- cluding insights into risk factors for decline, and its relationship to important outcomes; and the work will culmi- nate in a parsimonious set of physical function measures that can be used for clinical monitoring of physical health to inform treatment and prognostic decisions. This information could change how CKD patients are monitored in clinical care, guide patient-centered treatments, and promote broad improvement in physical func- tion for this high-risk population by catalyzing greater awareness and targeted interventions.