Although chronic renal insufficiency is the precursor to end-stage renal disease, few studies have examined the critical transition from advanced chronic renal insufficiency to end-stage renal disease. Basic and important questions, therefore, remain unanswered. For example: which patients with advanced chronic renal insufficiency are most likely to develop end-stage renal disease? How does cardiovascular disease evolve during the transition from advanced chronic renal insufficiency to end-stage renal disease? Howdo events and interventions during chronic renal insufficiency affect outcomes after onset of end-stage renal disease? The NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) study, which tracks a large cohort of individuals with chronic renal insufficiency, presents a unique opportunity to fill this important gap in knowledge. In this application, entitled """"""""CRIC-Plus,"""""""" we propose to intensify the study of patients who develop advanced chronic renal insufficiency and end-stage renal disease. Specifically, for patients whose glomerular filtration rate falls below 20 ml/min/1.73m2, renal function will be assessed every six months, additional echocardiograms at key clinical milestones will be performed and end-stage renal disease related parameters will be recorded.
Our specific aims complement and substantially extend the core aims of CRIC.
Aim #1 : To determine the frequency of progression to end-stage renal disease compared with death from competing causes among patients with glomerular filtration rate below 20 ml/min/1.73m2 and to identify predictors of these different outcomes.
Aim #2 : To compare left ventricular structure and function when glomerular filtration rate falls below 20 ml/min/1.73m2 with left ventricular structure and function at the onset of end-stage renal disease.
Aim #3 : To compare predicted risks of cardiovascularevents, hospitalization and death using exposures measured when glomerular filtration rate falls below 20 ml/min/1.73m2 with predicted risks using exposures measured at the onset of end-stage renal disease.
Aim #4 : To study the effect of chronic renal insufficiency management, including the timing of dialysis initiation, on clinical outcomes after onset of end-stage renal disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK070939-05
Application #
7791412
Study Section
Special Emphasis Panel (ZDK1-GRB-G (O2))
Program Officer
Kusek, John W
Project Start
2006-03-01
Project End
2013-02-28
Budget Start
2010-03-01
Budget End
2013-02-28
Support Year
5
Fiscal Year
2010
Total Cost
$391,386
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Bansal, Nisha; McCulloch, Charles E; Lin, Feng et al. (2016) Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease. Kidney Int 90:1348-1356
Bansal, Nisha; McCulloch, Charles E; Rahman, Mahboob et al. (2015) Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis: the chronic renal insufficiency cohort study. Hypertension 65:93-100
Grubbs, Vanessa; Plantinga, Laura C; Tuot, Delphine S et al. (2013) Americans' use of dietary supplements that are potentially harmful in CKD. Am J Kidney Dis 61:739-47
Bansal, Nisha; Keane, Martin; Delafontaine, Patrice et al. (2013) A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study. Clin J Am Soc Nephrol 8:355-62
Plantinga, Laura C; Tuot, Delphine S; Grubbs, Vanessa et al. (2012) Chronic kidney disease identification in a high-risk urban population: does automated eGFR reporting make a difference? J Urban Health 89:965-76
Grubbs, Vanessa; Plantinga, Laura C; Tuot, Delphine S et al. (2012) Chronic kidney disease and use of dental services in a United States public healthcare system: a retrospective cohort study. BMC Nephrol 13:16
Grubbs, Vanessa; Plantinga, Laura C; Vittinghoff, Eric et al. (2012) Medicare immunosuppressant coverage and access to kidney transplantation: a retrospective national cohort study. BMC Health Serv Res 12:254
Lee, Peter; Johansen, Kirsten; Hsu, Chi-yuan (2011) End-stage renal disease preceded by rapid declines in kidney function: a case series. BMC Nephrol 12:5
Grubbs, Vanessa; Plantinga, Laura C; Crews, Deidra C et al. (2011) Vulnerable populations and the association between periodontal and chronic kidney disease. Clin J Am Soc Nephrol 6:711-7

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