Design and implementation of the canadian kidney disease cohort study (CKDCS): A prospective observational study of incident hemodialysis patients

Abstract

BackgroundMany nephrology observational studies use renal registries, which have well known limitations. The Canadian Kidney Disease Cohort Study (CKDCS) is a large prospective observational study of patients commencing hemodialysis in five Canadian centers. This study focuses on delineating potentially reversible determinants of adverse outcomes that occur in patients receiving dialysis for end-stage renal disease (ESRD).Methods/DesignThe CKDCS collects information on risk factors and outcomes, and stores specimens (blood, dialysate, hair and fingernails) at baseline and in long-term follow-up. Such specimens will permit measurements of biochemical markers, proteomic and genetic parameters (proteins and DNA) not measured in routine care. To avoid selection bias, all consenting incident hemodialysis patients at participating centers are enrolled, the large sample size (target of 1500 patients), large number of exposures, and high event rates will permit the exploration of multiple potential research questions.Preliminary ResultsData on the baseline characteristics from the first 1074 subjects showed that the average age of patients was 62 (range; 50-73) years. The leading cause of ESRD was diabetic nephropathy (41.9%), and the majority of the patients were white (80.0%). Only 18.7% of the subjects received dialysis in a satellite unit, and over 80% lived within a 50 km radius of the nearest nephrologist's practice.DiscussionThe prospective design, detailed clinical information, and stored biological specimens provide a wealth of information with potential to greatly enhance our understanding of risk factors for adverse outcomes in dialysis patients. The scientific value of the stored patient tissue will grow as new genetic and biochemical markers are discovered in the future.

Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients

“…In this analysis, participants were followed for up to 2 years or until death, migration outside the study region, or withdrawal of consent, whichever came sooner. Details of the Canadian Kidney Disease Cohort Study are presented elsewhere (15).…”

Ethnic Differences in Prevalence of Peripheral Artery Disease in Patients Undergoing Hemodialysis

“…We conducted a secondary analysis of data from the Canadian Kidney Dialysis Cohort Study (CKDCS) [16]. The CKDCS is a large, prospective observational study of all consenting adults commencing hemodialysis treatment in multiple ethnically diverse major centres across Canada [16].…”

“…We conducted a secondary analysis of data from the Canadian Kidney Dialysis Cohort Study (CKDCS) [16]. The CKDCS is a large, prospective observational study of all consenting adults commencing hemodialysis treatment in multiple ethnically diverse major centres across Canada [16]. CKDCS was conducted according to the principles of the Declaration of Helsinki and approved by the ethics boards of each participating centre [16].…”

Renal Angiotensinogen Gene Expression and Tubular Atrophy in Diabetic Nephropathy

“…Diabetic nephropathy (DN) and retinopathy represent the major causes of end-stage renal disease and blindness (1-2) in developed countries. DN is associated with an increased risk of hypertension, adverse cardiovascular events (3), chronic kidney diseases and haemodialysis (4). Efforts are therefore being made to find ways of preventing and/or slowing down the progression of DN worldwide.…”

“…Although albuminuria is a useful clinical marker, tubulointerstitial fibrosis and tubular atrophy represent a better predictor of nephropathy progression because of their close association with declining renal function (5). Many randomized controlled trials have shown the efficacy of optimal glycemic control and RAS blockade in the primary and secondary prevention of DN (4,(7)(8)(9). The former is easily understood, as decreased "glucotoxicity" reduces end-organ damage.…”