Chronic Renal Insufficiency Cohort (CRIC) Study

Lash, James P.; Go, Alan S.; Appel, Lawrence J.; He, Jiang; Ojo, Akinlolu; Rahman, Mahboob; Townsend, Raymond R.; Xie, Dawei; Cifelli, Denise; Cohan, Janet; Fink, Jeffrey C.; Fischer, Michael J.; Gadegbeku, Crystal A.; Hamm, L. Lee; Kusek, John W.; Landis, J. Richard; Narva, Andrew S.; Robinson, Nancy; Teal, Valerie; Feldman, Harold I.

doi:10.2215/cjn.00070109

Cited by 517 publications

(474 citation statements)

References 51 publications

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“…The study design and baseline characteristics of participants have been described previously (17,18). The study protocol was approved by the institutional review board of each participating site; written informed consent was obtained from all participants.…”

Section: Methodsmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

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166

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Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. ResultsThe percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (23.2 ml/min per 1.73 m 2 ; 95% confidence interval, 25.5 to 20.9), higher proteinuria (+0.9 unit higher in log 2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m 2.7 ; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (23.6 ml/min per 1.73 m 2 ; 95% confidence interval, 26.1 to 21.1; versus 21.4 ml/min per 1.73 m 2 ; 95% confidence interval, 26.9 to 4.0, among those with nighttime BP ,120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

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Section: Methodsmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

Self Cite

166

118

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“…The design, methods, and baseline characteristics of the Chronic Renal Insufficiency Cohort (CRIC) study population have been published (18,19). Briefly, CRIC is a prospective observational study of patients with mild-to-moderate kidney disease that was established by the National Institute of Diabetes and Digestive and Kidney Diseases to examine risk factors for kidney and cardiovascular disease progression in CKD.…”

Section: Methodsmentioning

confidence: 99%

Relation of Serum Lipids and Lipoproteins with Progression of CKD

Rahman

Yang

Akkina

et al. 2014

Clinical Journal of the American Society of Nephrology

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137

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Background and objectives Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.Design, setting, participants, & measurements Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).Results Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m 2 ; 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria,0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria.0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.Conclusions In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.

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“…[15][16][17] The CRIC Study recruited 3939 adults from May 2003 to June 2008, aged 21-74 years, with mild to moderate CKD from general medicine and specialty clinics at seven clinical centers across the U.S. (Ann Arbor, Michigan; Baltimore, Maryland; Chicago, Illinois; Cleveland, Ohio; New Orleans, Louisiana; Philadelphia, Pennsylvania; and Oakland, California). Participants were followed with annual in-clinic visits and interim telephone contact.…”

Section: Study Populationmentioning

confidence: 99%

“…Exclusion criteria included inability to consent, institutionalization, pregnancy, and certain chronic conditions. [15][16][17] The study protocol was approved by Institutional Review Boards of participating centers and is in accordance with the principles of the Declaration of Helsinki. All study participants provided written informed consent.…”

Section: Study Populationmentioning

confidence: 99%

“…BP and anthropometric measures were obtained using standard protocols. 16 Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medications. History of CVD was defined as self-reported coronary heart disease (myocardial infarction or prior revascularization), heart failure, peripheral arterial disease, or stroke.…”

Section: Covariatesmentioning

confidence: 99%

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Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

et al. 2015

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BACKGROUND: Predialysis nephrology care for adults with late stage chronic kidney disease (CKD) is associated with improved outcomes. Less is known about the effects of nephrology care in earlier stages of CKD. OBJECTIVE: We aimed to evaluate the effect of nephrology care on management of CKD risk factors and complications, CKD progression, incident cardiovascular disease (CVD), and death. DESIGN: This was a prospective cohort study. PARTICIPANTS: Participants included 3855 men and women aged 21 to 74 years enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study with a mean (SD) estimated glomerular filtration rate (eGFR) at entry of 45 (17) ml/min/1.73 m 2 , followed for a median of 6.6 years. MAIN MEASURES: The main predictor was self-reported prior contact with a nephrologist at study enrollment. Outcomes evaluated included CKD progression (≥ 50 % eGFR loss or end-stage renal disease), incident CVD, and death. RESULTS: Two-thirds (67 %) of the participants reported prior contact with a nephrologist at study enrollment. They were younger, more likely to be male, non-Hispanic white, and had lower eGFR and higher urine protein (p < 0.05). A subgroup with eGFR 30-< 60 ml/min/1.73 m 2 and prior contact with a nephrologist were more likely to receive pharmacologic treatment for CKD-related complications and to report angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use. After propensity score matching (for reporting prior contact with a nephrologist vs. not) and adjusting for demographic and clinical variables, prior contact with a nephrologist was not significantly associated with CKD progression, incident CVD or death (p > 0.05). CONCLUSIONS: One-third of CRIC participants had not seen a nephrologist before enrollment, and this prior contact was subject to age, sex, and ethnic-related disparities. While prior nephrology care was associated with more frequent treatment of CKD complications and use of ACEi/ARB medications, there was neither an association between this care and achievement of guidelinerecommended intermediate measures, nor long-term adverse outcomes.

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Chronic Renal Insufficiency Cohort (CRIC) Study

Cited by 517 publications

References 51 publications

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Relation of Serum Lipids and Lipoproteins with Progression of CKD

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

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