Physical Function in Chronic Kidney Disease: Characterizing the Natural History and Relationship to Clinical Outcomes

慢性肾脏病的身体功能：自然史特征及其与临床结果的关系

基本信息

批准号：
10720426
负责人：
Sarah Jeanne Schrauben
金额：
$ 33.47万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-22 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10720426
关键词：
Adult Age Assessment tool Awareness Body Composition Caring Cessation of life Characteristics Chronic Kidney Failure Chronic Kidney Insufficiency Clinical Clinical Practice Guideline Cohort Studies Data Decision Making Disease Early Diagnosis Early Intervention Elderly Eligibility Determination Ensure Fatty acid glycerol esters Foundations General Population Glomerular Filtration Rate Goals Health High Prevalence Hospitalization Impairment Independent Living Intervention Intervention Trial Kidney Kidney Diseases Kidney Failure Kidney Transplantation Measures Monitor National Institute of Diabetes and Digestive and Kidney Diseases Natural History Outcome Participant Pathway interactions Patient Monitoring Patient Outcomes Assessments Patient Self-Report Patients Performance Persons Physical Function Physical Performance Physical assessment Population Population Heterogeneity Premature Mortality Prognosis Quality of life Recommendation Replacement Therapy Reporting Research Risk Risk Factors Self Management Services Testing Time Update Work adverse outcome clinical care clinical practice cohort disability evidence base follow-up frailty functional decline functional status high risk population improved improved outcome insight low socioeconomic status modifiable risk mortality patient oriented performance tests physical conditioning prevent prognostic risk stratification screening social health determinants therapy development tool treatment center young adult

项目摘要

Project Summary Functional status is defined by the ability to perform daily physical tasks necessary for independent living and is essential among persons with chronic kidney disease (CKD) for disease self-management, eligibility for kid- ney transplantation, and for ensuring good quality of life. People with CKD at all stages are at increased risk of poor physical functioning that occurs earlier than in the general population. Due to the high prevalence of phys- ical impairments among persons with CKD, the National Kidney Foundation clinical practice guidelines recom- mend regular assessments to identify those with physical limitations with the goal of improving outcomes. De- spite this acknowledgement of the importance of physical function to the health of persons with CKD, there has been limited research in the setting of CKD that would allow evidence-based clinical monitoring. To date, stud- ies in kidney disease populations have been limited by examining physical function at one time point, by evalu- ating relationships only with mortality, and by focusing largely on persons with kidney failure with replacement therapy (KFRT) and older adults. Early detection and intervention to prevent physical limitations and disability may be most effective if implemented during earlier stages of CKD and among younger adults. Risk factors of physical function decline have also been inadequately evaluated in persons with CKD and recommended physical function assessments are not routinely performed in CKD care. We propose to use nearly 20 years of follow up data from the NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) Study that represents diverse populations across the spectrum of CKD stages to enhance our understanding of the prognostic im- portance of physical function over time among persons with CKD, including insights to risk factors of physical function decline, and to build a clinical monitoring tool of physical function. We will characterize the trajectories of physical function along with their associated factors among people with CKD to increase the understanding of the pathways that lead to physical function decline and to identify modifiable factors for intervention develop- ment (Aim 1). We will determine the relationship of longitudinal physical function with onset of KFRT, hospitali- zations, and death (Aim 2). Lastly, we develop a monitoring tool for physical function that could guide treatment and prognostic decisions in CKD clinical practice. We will also test this tool in an external cohort with advanced CKD (Aim 3). Ultimately, the proposed study will increase our understanding of physical function in CKD, in- cluding insights into risk factors for decline, and its relationship to important outcomes; and the work will culmi- nate in a parsimonious set of physical function measures that can be used for clinical monitoring of physical health to inform treatment and prognostic decisions. This information could change how CKD patients are monitored in clinical care, guide patient-centered treatments, and promote broad improvement in physical func- tion for this high-risk population by catalyzing greater awareness and targeted interventions.

项目概要功能状态是指执行独立生活和必需的日常体力任务的能力对于患有慢性肾病（CKD）的人来说，对于疾病的自我管理、儿童治疗的资格至关重要肾移植，并确保良好的生活质量。患有各个阶段 CKD 的人患以下疾病的风险都会增加身体机能差的发生早于一般人群。由于物理现象的普遍存在 CKD 患者的功能障碍，国家肾脏基金会临床实践指南建议修正定期评估，以确定那些有身体限制的人，以改善结果。德- 尽管人们认识到身体功能对 CKD 患者健康的重要性，但在 CKD 背景下进行循证临床监测的研究有限。迄今为止，研究—— 通过在一个时间点检查身体功能，通过评估来限制肾脏疾病人群的健康状况只与死亡率建立关系，并主要关注肾衰竭患者进行替代疗法治疗（KFRT）和老年人。及早发现和干预，以防止身体限制和残疾如果在 CKD 早期阶段和年轻人中实施，可能会最有效。危险因素慢性肾病患者的身体功能下降也没有得到充分评估，并建议在 CKD 护理中并不常规进行身体功能评估。我们建议用近20年的时间 NIDDK 赞助的慢性肾功能不全队列 (CRIC) 研究的后续数据代表跨 CKD 阶段的不同人群，以增强我们对预后问题的理解慢性肾病患者身体机能随时间变化的重要性，包括对身体机能危险因素的深入了解功能下降，构建身体功能临床监测工具。我们将描述轨迹的特征慢性肾病患者的身体功能及其相关因素，以增加了解导致身体功能下降的途径，并确定干预开发的可改变因素换（目标 1）。我们将确定纵向身体机能与 KFRT 发生、住院期间的关系化和死亡（目标 2）。最后，我们开发了一种身体机能监测工具，可以指导治疗和 CKD 临床实践中的预后决策。我们还将在具有高级功能的外部队列中测试该工具 CKD（目标 3）。最终，拟议的研究将增加我们对 CKD 身体功能的理解，包括对衰退风险因素及其与重要结果的关系的见解；工作将会达到顶峰内特在一套简约的身体功能测量中，可用于临床监测身体健康状况为治疗和预后决策提供信息。这些信息可能会改变 CKD 患者的状况在临床护理中进行监测，指导以患者为中心的治疗，并促进身体功能的广泛改善通过提高认识和有针对性的干预措施来针对这一高危人群。