Estimating GFR Among Participants in the Chronic Renal Insufficiency Cohort (CRIC) Study

Anderson, Amanda H.; Yang, Wei; Hsu, Chi-yuan; Joffe, Marshall M.; Leonard, Mary B.; Xie, Dawei; Chen, Jing; Greene, Tom; Jaar, Bernard G.; Kao, Patricia F.; Kusek, John W.; Landis, J. Richard; Lash, James P.; Townsend, Raymond R.; Weir, Matthew R.; Feldman, Harold I.

doi:10.1053/j.ajkd.2012.04.012

Cited by 211 publications

(205 citation statements)

References 33 publications

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“…The following information and measures were obtained at study entry (baseline) and annually: demographic characteristics, medical history, medication use, height, weight, electrocardiogram, and serum and urine for laboratory assessments. An estimating equation developed from CRIC Study data was used to calculate eGFR (19).…”

Section: Methodsmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. ResultsThe percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (23.2 ml/min per 1.73 m 2 ; 95% confidence interval, 25.5 to 20.9), higher proteinuria (+0.9 unit higher in log 2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m 2.7 ; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (23.6 ml/min per 1.73 m 2 ; 95% confidence interval, 26.1 to 21.1; versus 21.4 ml/min per 1.73 m 2 ; 95% confidence interval, 26.9 to 4.0, among those with nighttime BP ,120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

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Section: Methodsmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

Self Cite

176

118

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“…Serum creatinine was measured at the University of Pennsylvania laboratory and standardized to isotope-dilution mass spectrometry reference values (20). The eGFR was calculated using the CRIC equation (21). Plasma lipids and lipoproteins were measured using standard laboratory assays; triglycerides, total cholesterol, and HDL-C were measured by spectrophotometry; VLDL-C and LDL-C were directly measured after separation by ultracentrifugation (b quantification), and apoA-I, apoB, and lipoprotein(a) [Lp(a)] were measured using immunoturbidimetric assays.…”

Section: Methodsmentioning

confidence: 99%

Relation of Serum Lipids and Lipoproteins with Progression of CKD

Rahman

Yang

Akkina

et al. 2014

Clinical Journal of the American Society of Nephrology

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148

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Background and objectives Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.Design, setting, participants, & measurements Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).Results Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m 2 ; 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria,0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria.0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.Conclusions In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.

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“…Anthropometric measurements and BP were measured by trained study personnel; 24-hour urine protein was measured for all participants at baseline, and a serum creatinine was measured at baseline and annually. eGFR was calculated using an equation developed in a subgroup of the CRIC Study participants with an iothalamate GFR (18).…”

Section: Variables and Data Sourcesmentioning

confidence: 99%

Predictors and Outcomes of Health–Related Quality of Life in Adults with CKD

Porter¹,

Lash²,

Xie³

et al. 2016

CJASN

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130

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Background and objectives Low health-related quality of life is associated with increased mortality in patients with ESRD. However, little is known about demographic and clinical factors associated with health-related quality of life or its effect on outcomes in adults with CKD.Design, settings, participants, & measurements Data from 3837 adult participants with mild to severe CKD enrolled in the prospective observational Chronic Renal Insufficiency Cohort and Hispanic Chronic Renal Insufficiency Cohort Studies were analyzed. Health-related quality of life was assessed at baseline with the Kidney Disease Quality of Life-36 and its five subscales: mental component summary, physical component summary, burden of kidney disease (burden), effects of kidney disease (effects), and symptoms and problems of kidney disease (symptoms). Low health-related quality of life was defined as baseline score .1 SD below the mean. Using Cox proportional hazards analysis, the relationships between low health-related quality of life and the following outcomes were examined: (1) CKD progression (50% eGFR loss or incident ESRD), (2) incident cardiovascular events, and (3) all-cause death.Results Younger age, women, low education, diabetes, vascular disease, congestive heart failure, obesity, and lower eGFR were associated with low baseline health-related quality of life (P,0.05). During a median follow-up of 6.2 years, there were 1055 CKD progression events, 841 cardiovascular events, and 694 deaths. Significantly higher crude rates of CKD progression, incident cardiovascular events, and all-cause death were observed among participants with low health-related quality of life in all subscales (P,0.05). In fully adjusted models, low physical component summary, effects, and symptoms subscales were independently associated with a higher risk of incident cardiovascular events and death, whereas low mental component summary was independently associated with a higher risk of death (P,0.05). Low health-related quality of life was not associated with CKD progression.Conclusions Low health-related quality of life across several subscales was independently associated with a higher risk of incident cardiovascular events and death but not associated with CKD progression.

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Estimating GFR Among Participants in the Chronic Renal Insufficiency Cohort (CRIC) Study

Cited by 211 publications

References 33 publications

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Relation of Serum Lipids and Lipoproteins with Progression of CKD

Predictors and Outcomes of Health–Related Quality of Life in Adults with CKD

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