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      International Network of Chronic Kidney Disease cohort studies (iNET-CKD): a global network of chronic kidney disease cohorts

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          Abstract

          Background

          Chronic kidney disease (CKD) is a global health burden, yet it is still underrepresented within public health agendas in many countries. Studies focusing on the natural history of CKD are challenging to design and conduct, because of the long time-course of disease progression, a wide variation in etiologies, and a large amount of clinical variability among individuals with CKD. With the difference in health-related behaviors, healthcare delivery, genetics, and environmental exposures, this variability is greater across countries than within one locale and may not be captured effectively in a single study.

          Methods

          Studies were invited to join the network. Prerequisites for membership included: 1) observational designs with a priori hypotheses and defined study objectives, patient-level information, prospective data acquisition and collection of bio-samples, all focused on predialysis CKD patients; 2) target sample sizes of 1,000 patients for adult cohorts and 300 for pediatric cohorts; and 3) minimum follow-up of three years. Participating studies were surveyed regarding design, data, and biosample resources.

          Results

          Twelve prospective cohort studies and two registries covering 21 countries were included. Participants age ranges from >2 to >70 years at inclusion, CKD severity ranges from stage 2 to stage 5. Patient data and biosamples (not available in the registry studies) are measured yearly or biennially. Many studies included multiple ethnicities; cohort size ranges from 400 to more than 13,000 participants. Studies’ areas of emphasis all include but are not limited to renal outcomes, such as progression to ESRD and death.

          Conclusions

          iNET-CKD (International Network of CKD cohort studies) was established, to promote collaborative research, foster exchange of expertise, and create opportunities for research training. Participating studies have many commonalities that will facilitate comparative research; however, we also observed substantial differences. The diversity we observed across studies within this network will be able to be leveraged to identify genetic, behavioral, and health services factors associated with the course of CKD. With an emerging infrastructure to facilitate interactions among the investigators of iNET-CKD and a broadly defined research agenda, we are confident that there will be great opportunity for productive collaborative investigations involving cohorts of individuals with CKD.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12882-016-0335-2) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function.

          The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for the progression of chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with CKD. We examined baseline demographic and clinical characteristics. Seven clinical centers recruited adults who were aged 21 to 74 yr and had CKD using age-based estimated GFR (eGFR) inclusion criteria. At baseline, blood and urine specimens were collected and information regarding health behaviors, diet, quality of life, and functional status was obtained. GFR was measured using radiolabeled iothalamate in one third of participants. A total of 3612 participants were enrolled with mean age +/- SD of 58.2 +/- 11.0 yr; 46% were women, and 47% had diabetes. Overall, 45% were non-Hispanic white, 46% were non-Hispanic black, and 5% were Hispanic. Eighty-six percent reported hypertension, 22% coronary disease, and 10% heart failure. Mean body mass index was 32.1 +/- 7.9 kg/m(2), and 47% had a BP >130/80 mmHg. Mean eGFR was 43.4 +/- 13.5 ml/min per 1.73 m(2), and median (interquartile range) protein excretion was 0.17 g/24 h (0.07 to 0.81 g/24 h). Lower eGFR was associated with older age, lower socioeconomic and educational level, cigarette smoking, self-reported CVD, peripheral arterial disease, and elevated BP. Lower level of eGFR was associated with a greater burden of CVD as well as lower socioeconomic and educational status. Long-term follow-up of participants will provide critical insights into the epidemiology of CKD and its relationship to adverse outcomes.
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            The Chronic Renal Insufficiency Cohort (CRIC) Study: Design and Methods.

            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.
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              Design of the Nephrotic Syndrome Study Network (NEPTUNE) to evaluate primary glomerular nephropathy by a multi-disciplinary approach

              The Nephrotic Syndrome Study Network (NEPTUNE) is a North American multi-center collaborative consortium established to develop a translational research infrastructure for Nephrotic Syndrome. This includes a longitudinal observational cohort study, a pilot and ancillary studies program, a training program, and a patient contact registry. NEPTUNE will enroll 450 adults and children with minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy for detailed clinical, histopathologic, and molecular phenotyping at the time of clinically-indicated renal biopsy. Initial visits will include an extensive clinical history, physical examination, collection of urine, blood and renal tissue samples, and assessments of quality of life and patient-reported outcomes. Follow-up history, physical measures, urine and blood samples, and questionnaires will be obtained every 4 months in the first year and bi-annually, thereafter. Molecular profiles and gene expression data will be linked to phenotypic, genetic, and digitalized histologic data for comprehensive analyses using systems biology approaches. Analytical strategies were designed to transform descriptive information to mechanistic disease classification for Nephrotic Syndrome and to identify clinical, histological, and genomic disease predictors. Thus, understanding the complexity of the disease pathogenesis will guide further investigation for targeted therapeutic strategies.
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                Author and article information

                Contributors
                thomas.dienemann@uk-erlangen.de
                nfujii@mail.med.upenn.edu
                orlandip@mail.med.upenn.edu
                nessel@mail.med.upenn.edu
                furths@email.chop.edu
                w.hoy@uq.edu.au
                smatsuo@med.nagoya-u.ac.jp
                gert.mayer@i-med.ac.at
                shona.methven@bristol.ac.uk
                franz.schaefer@med.uni-heidelberg.de
                elke.schaeffner@charite.de
                solalaura11@gmail.com
                benedicte.stengel@inserm.fr
                wanner_c@ukw.de
                luxia.zhang@gmail.com
                alevin@providencehealth.bc.ca
                kai-uwe.eckardt@uk-erlangen.de
                215-898-0901 , hfeldman@mail.med.upenn.edu
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                2 September 2016
                2 September 2016
                2016
                : 17
                : 1
                : 121
                Affiliations
                [1 ]Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
                [2 ]Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
                [3 ]Division of Pediatric Nephrology, Children’s Hospital of Philadelphia, Philadelphia, USA
                [4 ]Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland Australia
                [5 ]Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
                [6 ]Nephrology and Hypertension, Innsbruck Medical University, Innsbruck, Austria
                [7 ]School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, UK
                [8 ]Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
                [9 ]Institute of Public Health, Charite University Medicine, Berlin, Germany
                [10 ]Directora Division Epidemiologia, DIGESA-Ministerio Salud Publica, Montevideo, Uruguay
                [11 ]Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP, Centre for Research in Epidemiology and Population Health, Inserm, F-CRIN-INI-CRCT, Villejuif, France
                [12 ]Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
                [13 ]Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
                [14 ]Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
                [15 ]Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
                Article
                335
                10.1186/s12882-016-0335-2
                5010740
                27590182
                db2f23fd-05ff-4a92-bac7-aefaf6b8d6b7
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 April 2016
                : 17 August 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Nephrology
                cohort study,network,ckd,epidemiology,diversity
                Nephrology
                cohort study, network, ckd, epidemiology, diversity

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