The elderly are the fastest growing subset of the US population. Age-associated increases in chronic disease and disability represent a significant financial burden on the healthcare system. Glomerular filtration rate (GFR) declines with age and low GFR defines chronic kidney disease (CKD). Many older adults have CKD, which is an important risk factor for adverse outcomes. Accurate assessment of GFR is central to clinical decision-making, assessment of the public health burden, and investigation into the epidemiology of CKD in older adults. However, there is active debate about what constitutes """"""""normal"""""""" level of GFR in older adults and the best method to assess it. Creatinine based GFR estimates may not be accurate in older adults as malnutrition and loss of muscle mass, common with age and disease, affect serum creatinine independent of GFR. Cystatin C is an altnernative filtration marker not influenced by diet and muscle mass. The overall goal of this research is to explore the relationship of kidney function and aging.
Three aims are proposed: (1) Develop and validate GFR estimating eqations from cystatin C in the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) database (N>65 years= 1306). (2) Examine relationships among estimated GFR based on cystatin C, aging, nutrition, body composition, and mortality in the National Health and Nutrition Examination Survey (NHANES) (N>60 years= 7525). (3) Conduct a pilot study to examine the level of measured GFR in the general population of older adults (N=100) for subsequent implementation of ancillary studies to measure GFR in ongoing prospective cohort studies to provide information on normal levels of GFR across age and populations. A mentored, patient oriented Career Development Award is proposed to provide the candidate with rigorous methodological training and experience in clinical research related to kidney function and aging. The candidate proposes research projects and a career plan that includes didactic courses, expert advising, and mentored research to enhance the candidate's skills in complex statistical analyses of population based and longitudinal data, primary data collection and human subjects research, and to expand the candidate's kidney function and clinical geriatrics knowledge base. These projects and career development plan are consistent with the recognition by the Center for Disease Control of aging and chronic kidney disease as major public health problems.
|Viswanathan, Gautham; Sarnak, Mark J; Tighiouart, Hocine et al. (2013) The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis. Clin Nephrol 80:29-39|
|Juraschek, Stephen P; Coresh, Josef; Inker, Lesley A et al. (2013) Comparison of serum concentrations of Î²-trace protein, Î²2-microglobulin, cystatin C, and creatinine in the US population. Clin J Am Soc Nephrol 8:584-92|
|Grams, Morgan E; Juraschek, Stephen P; Selvin, Elizabeth et al. (2013) Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. Am J Kidney Dis 62:253-60|
|Krolewski, Andrzej S; Warram, James H; Forsblom, Carol et al. (2012) Serum concentration of cystatin C and risk of end-stage renal disease in diabetes. Diabetes Care 35:2311-6|
|Inker, Lesley A; Tonelli, Marcello; Hemmelgarn, Brenda R et al. (2012) Comparison of concurrent complications of CKD by 2 risk categorization systems. Am J Kidney Dis 59:372-81|
|Whaley-Connell, Adam; Shlipak, Michael G; Inker, Lesley A et al. (2012) Awareness of kidney disease and relationship to end-stage renal disease and mortality. Am J Med 125:661-9|
|Juraschek, Stephen P; Coresh, Josef; Inker, Lesley A et al. (2012) The effects of freeze-thaw on Î²-trace protein and Î²2-microglobulin assays after long-term sample storage. Clin Biochem 45:694-6|
|Inker, Lesley A; Shaffi, Kamran; Levey, Andrew S (2012) Estimating glomerular filtration rate using the chronic kidney disease-epidemiology collaboration creatinine equation: better risk predictions. Circ Heart Fail 5:303-6|
|Padala, Smita; Tighiouart, Hocine; Inker, Lesley A et al. (2012) Accuracy of a GFR estimating equation over time in people with a wide range of kidney function. Am J Kidney Dis 60:217-24|
|Tangri, Navdeep; Inker, Lesley A; Tighiouart, Hocine et al. (2012) Filtration markers may have prognostic value independent of glomerular filtration rate. J Am Soc Nephrol 23:351-9|
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