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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK081017-04
Application #
8069185
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
Project Start
2008-05-01
Project End
2013-04-30
Budget Start
2011-05-01
Budget End
2012-04-30
Support Year
4
Fiscal Year
2011
Total Cost
$169,668
Indirect Cost
Name
Tufts University
Department
Type
DUNS #
079532263
City
Boston
State
MA
Country
United States
Zip Code
02111
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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
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Shafi, Tariq; Matsushita, Kunihiro; Selvin, Elizabeth et al. (2012) Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III). BMC Nephrol 13:42
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
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
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
Juraschek, Stephen P; Coresh, Josef; Inker, Lesley A et al. (2012) The effects of freeze-thaw on ?-trace protein and ?2-microglobulin assays after long-term sample storage. Clin Biochem 45:694-6

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