The Chronic Renal Insufficiency Cohort (CRIC) Study is an ongoing, multicenter, longitudinal study of nearly 5500 adults with CKD in the United States. Over the past 10 years, the CRIC Study has made significant contributions to the understanding of factors associated with CKD progression. This review summarizes findings from longitudinal studies evaluating risk factors associated with CKD progression in the CRIC Study, grouped into the following six thematic categories: (1) sociodemographic and economic (sex, race/ethnicity, and nephrology care); (2) behavioral (healthy lifestyle, diet, and sleep); (3) genetic (apoL1, genome-wide association study, and renin-angiotensin-aldosterone system pathway genes); (4) cardiovascular (atrial fibrillation, hypertension, and vascular stiffness); (5) metabolic (fibroblast growth factor 23 and urinary oxalate); and (6) novel factors (AKI and biomarkers of kidney injury). Additionally, we highlight areas where future research is needed, and opportunities for interdisciplinary collaboration.

Background Hispanic persons living in the United States (U.S.) are at higher risk of infection and death from coronavirus disease 2019 (COVID-19) compared with non-Hispanic persons. Whether this disparity exists among critically ill patients with COVID-19 is unknown. Objective To evaluate ethnic disparities in mortality among critically ill adults with COVID-19 enrolled in the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID). Methods Multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICU) at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day mortality across racial/ethnic groups. Results A total of 2153 patients were included (994 [46.2%] Hispanic and 1159 [53.8%] non-Hispanic White). The median (IQR) age was 62 (51–71) years (non-Hispanic White, 66 [57–74] years; Hispanic, 56 [46–67] years), and 1462 (67.9%) were men. Compared with non-Hispanic White patients, Hispanic patients were younger; were less likely to have hypertension, chronic obstructive pulmonary disease, coronary artery disease, or heart failure; and had longer duration of symptoms prior to ICU admission. During median (IQR) follow-up of 14 (7–24) days, 785 patients (36.5%) died. In analyses adjusted for age, sex, clinical characteristics, and hospital size, Hispanic patients had higher odds of death compared with non-Hispanic White patients (OR, 1.44; 95% CI, 1.12–1.84). Conclusions Among critically ill adults with COVID-19, Hispanic patients were more likely to die than non-Hispanic White patients, even though they were younger and had lower comorbidity burden. This finding highlights the need to provide earlier access to care to Hispanic individuals with COVID-19, especially given our finding of longer duration of symptoms prior to ICU admission among Hispanic patients. In addition, there is a critical need to address ongoing disparities in post hospital discharge care for patients with COVID-19.

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Although the number of deaths due to coronavirus disease 2019 (COVID-19) is higher in men than women, prior studies have provided limited sex-stratified clinical data. We evaluated sex-related differences in clinical outcomes among critically ill adults with COVID-19. Multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day in-hospital mortality, severe acute kidney injury (AKI requiring kidney replacement therapy), and respiratory failure occurring within 14 days of intensive care unit admission. A total of 4407 patients were included (median age, 62 years; 2793 [63.4%] men; 1159 [26.3%] non-Hispanic White; 1220 [27.7%] non-Hispanic Black; 994 [22.6%] Hispanic). Compared with women, men were younger (median age, 61 vs 64 years, less likely to be non-Hispanic Black (684 [24.5%] vs 536 [33.2%]), and more likely to smoke (877 [31.4%] vs 422 [26.2%]). During median follow-up of 14 days, 1072 men (38.4%) and 553 women (34.3%) died. Severe AKI occurred in 590 men (21.8%), and 239 women (15.5%), while respiratory failure occurred in 2255 men (80.7%) and 1234 women (76.5%). After adjusting for age, race/ethnicity and clinical variables, compared with women, men had a higher risk of death (OR, 1.50, 95% CI, 1.26–1.77), severe AKI (OR, 1.92; 95% CI 1.57–2.36), and respiratory failure (OR, 1.42; 95% CI, 1.11–1.80). In this multicenter cohort of critically ill adults with COVID-19, men were more likely to have adverse outcomes compared with women.

Introduction: Chronic kidney disease (CKD) is associated with arrhythmias such as atrial fibrillation (AF) and sudden cardiac death, but limited rigorous data exist on the prevalence of AF, ventricular tachycardia (VT), nonsustained VT (NSVT), and high-degree atrioventricular (AV) block in a CKD cohort. Hypothesis: In participants with CKD, worse kidney function is associated with a higher burden of atrial and ventricular arrhythmias. Methods: We evaluated the prevalence of AF, VT, NSVT, and high degree AV block in participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who underwent monitoring using the ZIO XT patch, a noninvasive, 14-day continuous single-lead electrocardiogram monitor. We evaluated patient characteristics and the association between kidney function and each arrhythmia. Results: Among 1182 participants (mean age 69±9 years; 48% women), mean patch wear time was 11.9±3.8 days, and mean analyzable time was 95±11%. AF was detected in 82 (7.4%) participants, with AF burden (% time spent in AF) ranging from 0.1% to 100%, and the majority had long-standing, persistent AF. Participants with AF were older (74 vs 69 years, p<0.001), had a higher prevalence of cardiovascular disease including prior MI and heart failure (48% versus 34%, p<0.05); and had a higher body mass index (34 vs 32 kg/m 2 ; p<0.05) than those without AF. NSVT occurred in 31% of participants, while no participant experienced sustained VT. High-degree AV block was present 2 participants (<1%). Overall, pre-monitoring mean estimated glomerular filtration rate was 51±18 ml/min/1.73m2, and median urine albumin-to-creatinine ratio was 9.2 [4.4 - 44.6] mg/g. Kidney function or proteinturia were not independently associated with any of the arrhythmias. Conclusions: In adults with CKD undergoing 14-day continuous monitoring, AF was present in 1 in 14 indivduals, and nearly one-third had evidence of NSVT. Worsening kidney function was not independently associated with the prevalence of arrhythmias in this cohort. Future studies will need to assess the signficance of NSVT on cardiovascular events across the spectrum of CKD severity.