Kidney Disease Research Updates
Winter 2008

Research News

NIDDK Explores Traditional and Nontraditional Risk Factors for CKD and CVD

National Prospective Cohort Study of Chronic Kidney Disease Patients Continued

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) began the Chronic Renal Insufficiency Cohort (CRIC) Study, a national prospective observational cohort study of men and women with chronic kidney disease (CKD) in 2001. The CRIC Study had two major goals: to examine risk factors for rapid decline in kidney function and to examine risk factors for the development of cardiovascular disease (CVD) or the worsening of existing CVD.

With the recruitment of more than 3,500 subjects with CKD, “an enormous database that will contribute substantial insight into patients with CKD has been established,” said John Kusek, Ph.D., senior scientific advisor for the NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases.

“We need additional interventions for CKD,” Kusek said at an October National Kidney Disease Education Program coordinating panel meeting. “Hopefully, the CRIC Study will provide insights into both traditional and nontraditional risk factors for CKD and CVD that can be tested in clinical trials.”

A number of studies have explored the high cardiovascular mortality rates among patients with end-stage renal disease (ESRD), especially those on hemodialysis, compared to the general population. But little research has focused on the causes of cardiovascular morbidity and mortality in the earlier stages of CKD. Preliminary studies indicate people with CKD prior to ESRD are also at increased risk for CVD compared to people with normal kidney function.

CRIC’s subjects are between 21 to 74 years of age with stage 2 to 4 kidney disease, or a range from mild to severe loss of kidney function. Because African Americans are at increased risk for ESRD and diabetes is the leading cause of kidney failure in this country, the CRIC Study is well-represented by these groups, each making up nearly one half of the cohort.

A wide range of studies is being carried out in these subjects, including accurate assessmentof kidney function, measurement of coronary calcium, retinal photographs, echocardiograms, genetic investigation, and assessment of dietary intake, among others. Study investigators are carefully collecting information about cardiovascular, peripheral vascular, cerebrovascular, and kidney disease-related events, as well as death. This is by far the largest epidemiologic study of CKD prior to ESRD undertaken by the NIDDK.

NIDDK Repository

Data and specimens from this study will eventually find a home at the NIDDK Data and BioSample Repositories and will serve as a national resource for other investigators who are interested in studying CKD and CVD.

Study Organization

The study is being carried out at seven clinical centers and their satellites and coordinated by a Scientific and Data Coordinating Center at the following institutions:

• Johns Hopkins University and the University of Maryland, Baltimore
• University of Illinois at Chicago
• University of Michigan, Ann Arbor; Wayne State University, Detroit; and St. John’s Hospital, Detroit
• Kaiser Permanente of Northern California and the University of California, San Francisco
• Tulane University, New Orleans
• Case Western Reserve University, the Cleveland Clinic Foundation, and MetroHealth Medical Center, Cleveland
• University of Pennsylvania, Philadelphia (serves as a Clinical Center and the Scientific and Data Coordinating Center)

The NIDDK issued a Limited Competition Request for Applications to continue the study for a 5-year period beginning in July 2008.

For more information about CKD, go to www.kidney.niddk.nih.gov.

NIH Publication No. 08–4531
March 2008

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