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      The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study

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          Abstract

          Background

          While much has been learned about the epidemiology and treatment of end-stage renal disease (ESRD) in the last 30 years, chronic kidney disease (CKD) before the end-stage has been less investigated. Not enough is known about factors associated with CKD progression and complications, as well as its transition to ESRD. We designed the CKD-renal epidemiology and information network (REIN) cohort to provide a research platform to address these key questions and to assess clinical practices and costs in patients with moderate or advanced CKD.

          Methods

          A total of 46 clinic sites and 4 renal care networks participate in the cohort. A stratified selection of clinic sites yields a sample that represents a diversity of settings, e.g. geographic region, and public versus for-profit and non-for-profit private clinics. In each site, 60–90 patients with CKD are enrolled at a routine clinic visit during a 12-month enrolment phase: 3600 total, including 1800 with Stage 3 and 1800 with Stage 4 CKD. Follow-up will continue for 5 years, including after initiation of renal replacement therapy. Data will be collected from medical records at inclusion and at yearly intervals, as well as from self-administered patient questionnaires and provider-level questionnaires. Patients will also be interviewed at baseline, and at 1, 3 and 5 years. Healthcare costs will also be determined. Blood and urine samples will be collected and stored for future studies on all patients at enrolment and at study end, and at 1 and 3 years in a subsample of 1200.

          Conclusions

          The CKD-REIN cohort will serve to improve our understanding of the biological, clinical and healthcare system determinants associated with CKD progression and adverse outcomes as well as of international variations in collaboration with the CKD Outcome and Practice Pattern Study (CKDopps). It will foster CKD epidemiology and outcomes research and provide evidence to improve the health and quality of life of patients with CKD and the performances of the healthcare system in this field.

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          Most cited references38

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          Relation between kidney function, proteinuria, and adverse outcomes.

          The current staging system for chronic kidney disease is based primarily on estimated glomerular filtration rate (eGFR) with lower eGFR associated with higher risk of adverse outcomes. Although proteinuria is also associated with adverse outcomes, it is not used to refine risk estimates of adverse events in this current system. To determine the association between reduced GFR, proteinuria, and adverse clinical outcomes. Community-based cohort study with participants identified from a province-wide laboratory registry that includes eGFR and proteinuria measurements from Alberta, Canada, between 2002 and 2007. There were 920 985 adults who had at least 1 outpatient serum creatinine measurement and who did not require renal replacement treatment at baseline. Proteinuria was assessed by urine dipstick or albumin-creatinine ratio (ACR). All-cause mortality, myocardial infarction, and progression to kidney failure. The majority of individuals (89.1%) had an eGFR of 60 mL/min/1.73 m(2) or greater. Over median follow-up of 35 months (range, 0-59 months), 27 959 participants (3.0%) died. The fully adjusted rate of all-cause mortality was higher in study participants with lower eGFRs or heavier proteinuria. Adjusted mortality rates were more than 2-fold higher among individuals with heavy proteinuria measured by urine dipstick and eGFR of 60 mL/min/1.73 m(2) or greater, as compared with those with eGFR of 45 to 59.9 mL/min/1.73 m(2) and normal protein excretion (rate, 7.2 [95% CI, 6.6-7.8] vs 2.9 [95% CI, 2.7-3.0] per 1000 person-years, respectively; rate ratio, 2.5 [95% CI, 2.3-2.7]). Similar results were observed when proteinuria was measured by ACR (15.9 [95% CI, 14.0-18.1] and 7.0 [95% CI, 6.4-7.6] per 1000 person-years for heavy and absent proteinuria, respectively; rate ratio, 2.3 [95% CI, 2.0-2.6]) and for the outcomes of hospitalization with acute myocardial infarction, end-stage renal disease, and doubling of serum creatinine level. The risks of mortality, myocardial infarction, and progression to kidney failure associated with a given level of eGFR are independently increased in patients with higher levels of proteinuria.
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            Progress in development of the index of ADL.

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              Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

              Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.
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                Author and article information

                Journal
                Nephrol Dial Transplant
                Nephrol. Dial. Transplant
                ndt
                ndt
                Nephrology Dialysis Transplantation
                Oxford University Press
                0931-0509
                1460-2385
                August 2014
                24 September 2013
                24 September 2013
                : 29
                : 8
                : 1500-1507
                Affiliations
                [1 ]Inserm, U1018, CESP Centre for Research in Epidemiology and Population Health, Team 10, Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team , Villejuif, France
                [2 ]Paris Sud Univ, UMRS 1018 , Villejuif, France
                [3 ]Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux , Bordeaux, France
                [4 ]Inserm, U1026, Univ Bordeaux Segalen , Bordeaux, France
                [5 ]Agence de la Biomédecine, Saint-Denis, France
                [6 ]Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy , Vandoeuvre-lès-Nancy, France
                [7 ]Nephrology Department, Centre Hospitalier LYON-SUD , Pierre-Bénite, France
                [8 ]CarMeN, CENS and Univ Lyon, Lyon, France
                [9 ]Nephrology Department, CHU de Nancy , Vandoeuvre-lès-Nancy
                [10 ]Jean Moulin Lyon 3 University, The Institute for Education and Research in Health Care and Social Service , Lyon, France
                [11 ]Biobanque de Picardie, Amiens, France
                [12 ]Centre Hospitalier Universitaire , Amiens, France
                [13 ]Centre National de Génotypage, CEA , Evry, France
                [14 ]Institute of Cardiovascular and Metabolic Disease, Inserm U1048 , Toulouse, France
                [15 ]Université Toulouse III Paul-Sabatier , Toulouse, France
                [16 ]Arbor Research Collaborative for Health , Ann Arbor, MI, USA
                [17 ]Inserm U1088, Amiens University Hospital , Amiens, France
                [18 ]Nephrology Department, CHU Ambroise Pare , Boulogne, France
                Author notes
                Correspondence and offprint requests to: Bénédicte Stengel; E-mail: benedicte.stengel@ 123456inserm.fr
                [*]

                These authors contributed equally to this work.

                Article
                gft388
                10.1093/ndt/gft388
                4106639
                24064325
                68289fff-dd7c-4246-89f0-d4105de59af9
                © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits noncommercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 27 April 2013
                : 5 August 2013
                Categories
                Cutting-Edge Renal Science
                Reviews - Clinical Science and Outcome Research in Nephrology

                Nephrology
                biomarkers,chronic kidney disease,clinical practice,cohort,quality of life
                Nephrology
                biomarkers, chronic kidney disease, clinical practice, cohort, quality of life

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