Transition of Care in CKD (TC-CKD)

CKD 护理过渡 (TC-CKD)

基本信息

批准号：
9273515
负责人：
STEVEN J JACOBSEN
金额：
$ 55.4万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-10 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9273515
关键词：
Acute Renal Failure with Renal Papillary Necrosis Age Anemia Annual Reports Area Blood Pressure Blood Vessels Bone Diseases California Caring Categories Catheters Chronic Kidney Failure Clinical Comorbidity Comorbidity Index Data Databases Decision Making Dialysis procedure Disease Disease Progression End stage renal failure Event Fistula Frequencies Healthcare Systems Heart failure Hemodialysis Home environment Hospitalization Hypothyroidism Intercept Interruption Kidney Diseases Kidney Transplantation Knowledge Laboratories Link Liver diseases Malnutrition Measures Metabolic acidosis Minerals Modality Obesity Outcome Patients Peritoneal Peritoneal Dialysis Preparation Proteins Renal Replacement Therapy Research Personnel Research Project Grants Speed System Testing Transplant Recipients Transplantation Uncertainty Veterans Withdrawal base cohort cost demographics diabetes control end of life care frailty glycemic control hypercholesterolemia hypertension treatment innovation longitudinal database mortality outcome prediction personalized approach prospective public health relevance trend wasting

项目摘要

DESCRIPTION (provided by applicant): In patients with very-late-stage non-dialysis dependent (NDD) CKD (eGFR <25 ml/min/1.73 m2) the optimal transition of care to renal replacement therapy (RRT, i.e., dialysis or transplantation) is not known. Major uncertainty and significant knowledge gaps have persisted pertaining to differential or individualized transitions of care across different age and demographics and different pre-RRT comorbid conditions and events in several key areas including: (1) the best timing for RRT initiation; (2) the optimal RRT type (dialysis vs. transplant); and in the case of dialysis, the best modality (hemo- vs. peritoneal), format (in-center vs. home), frequency (daily vs. infrequent) and vascular access preparation; (3) the post-RRT impact of pre-RRT comorbid conditions and events including blood pressure and glycemic control, acute kidney injury episodes, and management of CKD specific conditions such as anemia and mineral disorders; and (4) the impact of the above pre-RRT conditions on end-of-life care and decision-making. Given the enormous changes occurring in our health care system and given the high costs of dialysis therapy with persistently poor outcomes, there is an urgent need to answer these important questions related to CKD transitions to RRT. Given the inherent limitations of the USRDS that lacks most core data prior to the RRT transition intercept, we propose a highly innovative linkage approach between the USRDS and two exceptionally rich and large longitudinal databases of very-late-stage NDD-CKD patients, i.e., the national (entire US) Veterans Affairs (VA) database and the regional (Southern California) Kaiser Permanente (KPSC) database, each consisting of millions of people including over 20,000 NDD-CKD patients with eGFR<25 ml/min who transitioned to RRT over the 5-year period 1/1/2008-1/1/2013. These cohorts will also provide annual linkage to projected (2013- 2016) data from over 4,000 incident ESRD patients including several hundred kidney transplant recipients each year for 4 years, hence adding over 16,000 linked patients who will transition to RRT. We hypothesize that (1) a pre-RRT data-driven individualized approach to the transition of care into RRT in very-late-stage CKD is associated with more favorable outcomes including greater survival, fewer hospitalizations and reduced costs, if the decision is based on pre-RRT factors such as clinical and lab variables including the CKD progression rate and comorbid conditions combined with demographics, and (2) that a scoring system derived from these pre-RRT data can determine the timing, preparation and modality of RRT to achieve better outcomes. Upon linking the national VA and regional KPSC data with the USRDS to identify those who have transitioned to dialysis or transplantation, we will examine the predictors of short- (first 6 months) and long-term mortality, hospitalizations and costs by generating pertinent de novo variables including pre-RRT eGFR slope, laboratory data trends and comorbidity indices; and these pre-RRT variables on >36,000 transitioned patients will be linked and reported annually and eventually become available to the USRDS to share with researchers.

描述（由申请人提供）：在具有非常局部阶段的非透析依赖性（NDD）CKD（EGFR <25 mL/min/1.73 m2）的患者中，未知护理到肾脏替代疗法（即透析或移植）的最佳过渡。主要的不确定性和重大知识差距一直存在于不同年龄和人口统计学的差异或个性化的护理过渡以及在几个关键领域的不同PRRT合并条件和事件的不同，包括：（1）RRT启动的最佳时机；（2）最佳RRT 类型（透析与移植）；在透析的情况下，最好的形态（血液与腹膜），格式（中心与家庭），频率（每日与频繁）和血管通道准备；（3）RRT前RRT合并症和事件的影响，包括血压和血糖控制，急性肾脏损伤发作以及CKD特定疾病（例如贫血和矿物质疾病）的管理；（4）上述RRT条件对寿命终止护理和决策的影响。鉴于我们的医疗保健系统发生了巨大的变化，并且鉴于透析治疗的高成本持续不佳，因此迫切需要回答与RRT的CKD过渡有关的这些重要问题。鉴于USRD在RRT过渡截距之前缺乏大多数核心数据的固有局限性，我们提出了USRDS和两个非常富有和大的纵向数据库之间的高度创新的链接方法数据库，每个数据库由数百万人组成，其中包括超过20,000名EGFR <25 ml/min的NDD-CKD患者，他们在5年期间过渡到RRT 1/1/2008-1/1/2013。这些队列还将与预计（2013-2016）的年度联系（2013-2016），来自4,000多名ESRD患者，包括每年4年的数百例肾脏移植受者，因此增加了16,000多名将过渡到RRT的链接患者。 We hypothesize that (1) a pre-RRT data-driven individualized approach to the transition of care into RRT in very-late-stage CKD is associated with more favorable outcomes including greater survival, fewer hospitalizations and reduced costs, if the decision is based on pre-RRT factors such as clinical and lab variables including the CKD progression rate and comorbid conditions combined with demographics, and (2) that a scoring system derived from these RRT前数据可以确定RRT的时间，准备和方式，以实现更好的结果。将国家VA和区域KPSC数据与USRD联系起来，以识别那些已经过渡到透析或移植的人，我们将检查短期（前6个月）以及长期死亡率，住院和成本的预测因素，通过产生与NOVO相关的变量，包括Pre-Rrt EGFR SLOPE SLOPE SLOPE，实验室数据趋势和Comors and Comorbity and Comorbities andines;这些> 36,000名转型患者的前RRT变量每年将连接并报告，并最终可向USRDS提供与研究人员共享。