The Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Abstract. Insights into end-stage renal disease have emerged from many investigations but less is known about the epidemiology of chronic renal insufficiency (CRI) and its relationship to cardiovascular disease (CVD). The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for progression of CRI and CVD among CRI patients and develop models to identify high-risk subgroups, informing future treatment trials, and increasing application of preventive therapies. CRIC will enroll approximately 3000 individuals at seven sites and follow participants for up to 5 yr. CRIC will include a racially and ethnically diverse group of adults aged 21 to 74 yr with a broad spectrum of renal disease severity, half of whom have diagnosed diabetes mellitus. CRIC will exclude subjects with polycystic kidney disease and those on active immunosuppression for glomerulonephritis. Subjects will undergo extensive clinical evaluation at baseline and at annual clinic visits and via telephone at 6 mo intervals. Data on quality of life, dietary assessment, physical activity, health behaviors, depression, cognitive function, health care resource utilization, as well as blood and urine specimens will be collected annually.125 I-iothalamate clearances and CVD evaluations including a 12-lead surface electrocardiogram, an echocardiogram, and coronary electron beam or spiral CT will be performed serially. Analyses planned in CRIC will provide important information on potential risk factors for progressive CRI and CVD. Insights from CRIC should lead to the formulation of hypotheses regarding therapy that will serve as the basis for targeted interventional trials focused on reducing the burden of CRI and CVD.The rate of ESRD has increased steadily in the United States over the past three decades. Insights into the epidemiology and treatment of ESRD have emerged from many investigations including those conducted by the United States Renal Disease System. Much less is known about the epidemiology of pre-ESRD chronic renal insufficiency (CRI), especially the relationship between CRI and cardiovascular disease (CVD).CRI has been recognized as a silent epidemic (1) affecting more than ten million Americans. The burden of morbidity and mortality from CRI derives from the progression of CRI to ESRD and the disproportionate risk of CVD in the setting of CRI. CRI is strongly and independently associated with CVD, even after adjustment for traditional CVD risk factors. These findings led to the hypothesis that specific "uremia-related risk factors" augment the rate of CVD (2) and cause many patients with CRI to succumb to fatal cardiovascular events before needing renal replacement therapy.The National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) established the Chronic Renal Insufficiency Cohort (CRIC) Study in 2001 to improve understanding of the relationship between CRI and CVD. The CRIC Study goals are to examine risk factors for progression of CRI and CVD among patients with CRI and develop predictive mo...

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

“…CVD events were adjudicated by physician reviewers. 15 Deaths were ascertained from next of kin reports, death certificates, hospital records, and linkage with the Social Security Death Master File. Participants were followed up until the occurrence of death, voluntary withdrawal, or 31 March 2012.…”

“…[15][16][17] The CRIC Study recruited 3939 adults from May 2003 to June 2008, aged 21-74 years, with mild to moderate CKD from general medicine and specialty clinics at seven clinical centers across the U.S. (Ann Arbor, Michigan; Baltimore, Maryland; Chicago, Illinois; Cleveland, Ohio; New Orleans, Louisiana; Philadelphia, Pennsylvania; and Oakland, California). Participants were followed with annual in-clinic visits and interim telephone contact.…”

“…Exclusion criteria included inability to consent, institutionalization, pregnancy, and certain chronic conditions. [15][16][17] The study protocol was approved by Institutional Review Boards of participating centers and is in accordance with the principles of the Declaration of Helsinki. All study participants provided written informed consent.…”

Cohort Studies

“…In response to the rising epidemic of CKD and its associated consequences, namely cardiovascular disease and progression to ESRD, the National Institute of Diabetes and Digestive and Kidney Diseases established the Chronic Renal Insufficiency Cohort (CRIC) Study in 2001 (20). Overarching goals for this prospective cohort study focused on identifying nontraditional risk factors for cardiovascular morbidity and mortality and risk factors for progression toward ESRD.…”

Design and Methods of the Chronic Kidney Disease in Children (CKiD) Prospective Cohort Study

“…t has been estimated that 650,000 Americans will have ESRD by 2010 with an annual cost of $28 billion per year (1,2). Although alarming increases in ESRD rates have occurred in older Americans, young adults with ESRD bear a sizable burden of the disease.…”