Chronic Renal Insufficiency Cohort Study II

据估计，患有轻中度慢性肾功能不全(CRI)的美国人的数量 超过1000万，而且还在不断增长。然而，令人惊讶的是，人们对这种疾病的流行病学、护理和 慢性肾功能衰竭患者的预后。此外，进展为终末期肾病和 CRI对心血管和外周血管疾病风险的影响尚不清楚。 我们建议建立一个联合旧金山湾区临床中心，由凯撒永久医院 北加州大学和加州大学旧金山分校为NIDDK赞助的 3000名轻中度CRI患者的队列。我们将招收520名科目：410名来自Kaiser Permanente和来自加州大学旧金山分校的110名受试者以及提供独特的， 来自Kaiser的肾功能保留的大型自动配对成人队列。的具体目标 这项研究包括： 目的1：描述非卧床患者肾功能不全的进展情况，并确定 肾功能迅速恶化的预测指标。 目的2：确定心血管、脑血管和外周血管的风险 事件与肾功能不全的严重程度及其关系如何相关 受“传统”和“新”血管危险因素影响的不同患者亚组。 目的3：评估慢性肾脏病患者在获得和护理质量方面的差异 在社会人口子组、地理区域和卫生系统方面的不足 及其与临床结局的关系 目的4：评价测定肾小球滤过率的临床和预后价值。 按体表面积与血清肌酐比较归一化，估计或测量 肌酐清除量、估计的肾小球滤过率和测量的绝对肾小球 不同人口统计和疾病亚组的滤过率

The number of Americans who suffer from mild-to-moderate chronic renal insufficiency (CRI) is estimated to be over 10 million and growing. However, remarkably little is known about the epidemiology, care, and outcomes of patients with CRI. Furthermore, the predictors of progression to end-stage renal disease and the impact of CRI on the risk of cardiovascular and peripheral vascular disease are not well understood. We propose to establish a joint San Francisco Bay Area Clinical Center between Kaiser Permanente of Northern California and the University of California, San Francisco to contribute to the NIDDK-sponsored cohort of 3000 patients with mild-to-moderate CRI. We will enroll 520 subjects: 410 from Kaiser Permanente and 110 subjects from the University of California, San Francisco as well as provide a unique, large automated matched cohort of adults from Kaiser with preserved renal function. The specific aims of the study are: Aim 1: To characterize the progression of renal insufficiency in ambulatory patients and to identify predictors of rapid deterioration of renal function. Aim 2: To determine how the risk of cardiovascular, cerebrovascular, and peripheral vascular events is associated with the severity of renal insufficiency and how its relationship is affected by "traditional" and "novel" vascular risk factors in different patient subgroups. Aim 3: To assess the variation in the access and quality of care for patients with chronic renal insufficiency across sociodemographic subgroups, geographic areas, and health systems and its association with clinical outcomes Aim 4: To evaluate the clinical and prognostic utility of measured glomerular filtration rate normalized to body surface area compared to serum creatinine, estimated or measured creatinine clearance, estimated glomerular filtration rate and measured absolute glomerular filtration rate across different demographic and disease subgroups