Chronic Renal Insufficiency Cohort Study (CRIC)

Denker, Matthew G.; Boyle, Suzanne; Anderson, Amanda H.; Appel, Lawrence J.; Chen, Jing; Fink, Jeffrey C.; Flack, John M.; Go, Alan S.; Horwitz, Edward; Hsu, Chi-yuan; Kusek, John W.; Lash, James P.; Navaneethan, Sankar D.; Ojo, Akinlolu; Rahman, Mahboob; Steigerwalt, Susan; Townsend, Raymond R.; Feldman, Harold I.

doi:10.2215/cjn.04260415

Cited by 102 publications

(82 citation statements)

References 51 publications

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“…Depending on the age, the eGFR limits for inclusion are between 20 and 70 ml/min/1.73m 2 and the renal endpoints considered are the need for renal replacement therapy, a reduction of eGFR by 50% and/or a decline of eGFR by at least 25 ml/min/1.73m 2 [7, 8]. When compared to non-diabetic participants, patients with diabetes were more likely to suffer from comorbidities like myocardial infarction (28 vs 16%), congestive heart failure (14 vs 6%) or peripheral vascular disease (10 vs 3%) [9]. The mean eGFR in diabetic participants was 41 ml/min/1.73m 2 , the mean HbA1c level 7.7% and about 80% were on RAS blocking agents [9].…”

Section: Discussionmentioning

confidence: 99%

“…When compared to non-diabetic participants, patients with diabetes were more likely to suffer from comorbidities like myocardial infarction (28 vs 16%), congestive heart failure (14 vs 6%) or peripheral vascular disease (10 vs 3%) [9]. The mean eGFR in diabetic participants was 41 ml/min/1.73m 2 , the mean HbA1c level 7.7% and about 80% were on RAS blocking agents [9]. …”

Section: Discussionmentioning

confidence: 99%

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A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) – Study Design and Baseline Characteristics

Eder

Leierer

Kerschbaum

et al. 2018

Kidney Blood Press Res

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Background/Aims: The prevalence of diabetes mellitus type 2 and kidney disease in these patients varies widely between European countries. Methods: In addition to store bio-samples the “Prospective cohort study in patients with type 2 diabetes mellitus for validation of biomarkers” collects information on history, physical status, laboratory measurements and medication in 4000 patients with diabetes mellitus type 2, being taken care of at the primary level of healthcare in 5 European countries (Austria, Hungary, Netherlands, Poland and Scotland). Next to comparing the rate of loss of eGFR between the countries, a further objective of the PROVALID study is to determine the 5-year cumulative incidence of renal and cardiovascular outcomes. Results: The mean age of the population recruited is 62.9±10 years, 54.6% are male and the mean BMI is 30.9±5.4 kg/m². Metabolic control (median HBA1c 6.8 % (6.2; 7.5)) is achieved via administration of metformin in 67.4% of the patients and insulin in 30.3%. Median systolic and diastolic blood pressure at recruitment is 135 (125; 146) and 80 (72; 85) mmHg, 65.4% of subjects received RAAS blocking agents. Mean eGFR is 80.7±29.2 ml/min/1.73m² and median baseline albumin/creatinine ratio 8.3 mg (IQR: 3.8 and 25.1). Conclusion: PROVALID will provide information on incidence and progression of renal and cardiovascular disease and therapy in patients with type 2 diabetes mellitus in different European countries. Thus, in contrast to many other cohort studies we will be able to associate national clinical practise pattern with outcome in this highly vulnerable patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) – Study Design and Baseline Characteristics

Eder

Leierer

Kerschbaum

et al. 2018

Kidney Blood Press Res

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“…Regarding depression, it has been repeatedly shown that depression is common and underrecognized in patients with advanced CKD or end-stage-renal disease [43] . Whether or not less severe forms of impaired kidney function (eGFR ≥ 30 or even ≥ 45 mL/min/1.73 m 2 ) are associated with more depressive symptoms compared to preserved kidney function (eGFR ≥ 60 mL/min/1.73 m 2 ) is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Mild-to-Moderate Chronic Kidney Disease and Geriatric Outcomes: Analysis of Cross-Sectional Data from the Berlin Aging Study II

et al. 2017

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Background: Mild-to-moderate chronic kidney disease (CKD G3a) is prevalent in older adults. Substantial evidence suggests that individuals with advanced CKD face a high risk for common geriatric conditions, like functional impairment and cognitive decline, whereas the relationships between mild-to-moderate CKD and functional impairment and cognitive decline, but also poor nutritional status and mood disorders, are still unclear. Objective: The aim of this study was to explore associations between mild-to-moderate CKD and impairments in the core domains of geriatric assessment (GA) in a large cohort of community-dwelling older adults. Methods: This was a cross-sectional analysis of 1,476 participants of the Berlin Aging Study II. Study participants were stratified as to presence or absence of CKD G3a (estimated glomerular filtration rate [eGFR] 45-59 mL/min/1.73 m² vs. eGFR ≥60 mL/min/1.73 m²). GA comprised the following instruments: the Activities of Daily Living Scale (ADL), the Timed up and Go (TUG), the Tinetti test (Tinetti), the Mini-Mental-State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Mini Nutritional Assessment (MNA). We used logistic regression models to estimate multivariable-adjusted associations between CKD G3a and impairments in the respective domains. Results: A total of 282 subjects with mild-to-moderate CKD (CKD G3a) were identified (19.1%). Overall, the prevalence of impairments identified was higher among subjects with compared to without CKD G3a (21 vs. 15.9%, p = 0.043). In multivariable-adjusted models, CKD G3a was consistently associated with increased odds of an impaired gait performance as to the TUG (adjusted odds ratio 2.06, 95% CI 1.04-4.09). In contrast, on average, individuals with and without CKD G3a did not differ as to their results in the MMSE, the ADL, the MNA, and the GDS. Conclusion: GA identified impairments in 21 versus 15.9% of older adults with and without mild-to-moderate CKD, respectively. However, except for an increased likelihood of impaired gait performance (TUG) with mild-to-moderate CKD, we did not find independent associations between mild-to-moderate CKD and geriatric conditions.

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“…Kidney function was measured as eGFR using the CKD-EPI (CKD Epidemiology Collaboration) creatinine equation; and albuminuria quantified as total albumin excretion in a 24 hour urine collection. Per the CRIC protocol, measured iothalamate glomerular filtration rate (iGFR) was performed by urine clearance in 1/3 of the cohort 16,22 .…”

Section: Methodsmentioning

confidence: 99%

Acid Load and Phosphorus Homeostasis in CKD

Khairallah

Isakova

Asplin

et al. 2017

American Journal of Kidney Diseases

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Background The kidneys maintain acid-base homeostasis through excretion of acid as either ammonium or as titratable acids (TA) that primarily use phosphate as a buffer. In CKD, ammoniagenesis is impaired, promoting metabolic acidosis. Metabolic acidosis stimulates phosphaturic hormones, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) in vitro, possibly to increase urine TA buffers, but this has not been confirmed in humans. We hypothesized that higher acid load and acidosis would associate with altered phosphorus homeostasis including higher urinary phosphorus, PTH and FGF-23. Study Design Cross-sectional Setting & Participants 980 participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study Predictors Net acid excretion as measured in 24-hour urine, potential renal acid load (PRAL) estimated from food frequency questionnaire responses, and serum bicarbonate < 22 mEq/L Outcome & Measurements 24h urine phosphorus and calcium; serum phosphorus, FGF-23, and PTH Results Using linear and log-linear regression adjusted for demographics, kidney function, comorbidities, body mass index, diuretic use and 24h urine creatinine, we found that 24h urine phosphorus was higher at higher net acid excretion, higher PRAL, and lower serum bicarbonate (each p<0.05). Serum phosphorus was also higher with higher net acid excretion and lower serum bicarbonate (each p=0.001). Only higher net acid excretion associated with higher 24h urine calcium excretion (p<0.001). Neither net acid excetion nor PRAL were associated with FGF-23 or PTH. PTH, but not FGF-23 (p=0.2), was 26% (95% CI, 13%-40%) higher in participants with a serum bicarbonate 22< vs ≥22 mEq/L (P<0.001). Primary results were similar if stratified by eGFR categories, or if adjusted for iothalamate GFR (n=359), total energy intake, dietary phosphorus or urine urea nitrogen, where available. Limitations Possible residual confounding by kidney function or nutrition; urine phosphorus was included in calculation of the titratable acid component of net acid excretion Conclusions In CKD, higher acid load and acidosis associates independently with increased circulating phosphorus and augmented phosphaturia, but not consistently with FGF-23 or PTH. This may be an adaptation that increases TA excretion, and thus helps maintain acid-base homeostasis in CKD. Understanding if administration of base can lower phosphorus requires testing in interventional trials.

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Chronic Renal Insufficiency Cohort Study (CRIC)

Cited by 102 publications

References 51 publications

A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) – Study Design and Baseline Characteristics

A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) – Study Design and Baseline Characteristics

Mild-to-Moderate Chronic Kidney Disease and Geriatric Outcomes: Analysis of Cross-Sectional Data from the Berlin Aging Study II

Acid Load and Phosphorus Homeostasis in CKD

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