Chronic Renal Insufficiency Cohort (CRIC) Study

A NIH-sponsored study to examine risk factors for the progression of renal disease and development of cardiovascular disease in patients with chronic renal insufficiency

Investigators
Jiang He, MD, PhD, Principal Investigator
Jing Chen, Co-Investigator
Vivian Fonseca, MD, Co-Investigator
L. Lee Hamm, MD, Co-Investigator
Paul Muntner, PhD, Co-Investigator
Paolo Raggi, MD, Co-Investigator
Paul K. Whelton, MD, MSc, Co-Investigator

Funding Agent
National Institute of Diabetes and Digestive and Kidney Diseases, NIH

Participating Institutes
Tulane University
University of Pennsylvania
Johns Hopkins University/University of Maryland
Case Western Reserve University
University of Michigan at Ann Arbor
University of Illinois at Chicago
Kaiser Permanente of Northern California/University of California at San Francisco

Description
Chronic kidney disease is an underrecognized and undertreated condition that is a "silent epidemic" in the US population. Although patients with chronic kidney disease are at extremely high risk for end-stage renal disease and cardiovascular disease, there have only been a few epidemiological studies that have examined risk factors for end-stage renal disease or cardiovascular disease in patients with chronic kidney disease.

The overall objective of the Chronic Renal Insufficiency Cohort (CRIC) study is to establish an enduring, collaborative research group capable of examining hypotheses concerning disease etiology, diagnosis, health outcomes, and health services utilization among a cohort of patients with chronic kidney disease. The two main hypothesis are a) A set of non-traditional risk factors is associated with both progression of chronic kidney disease and the development of end-stage renal disease and b) a set of non-traditional risk factors is associated with cardiovascular events and subclinical measures of cardiovascular disease progression in the setting of chronic kidney disease. The CRIC study is a prospective cohort study of 3000 racially diverse adult patients at 7 clinical centers across the US, with mild to moderate chronic kidney disease. Half of CRIC participants will have diabetes, their ages will range from 21-74 years, and their estimated glomerular filtration rate at entry will be stratified by age. Baseline evaluation will include estimation of renal function (by iothalamate clearance in a subset), assessment of sociodemographics, prior comorbidity and treatment, psychosocial attributes, quality of life, prior health care resource utilization as well as anthropometry and selected biochemical measures. Subclinical cardiovascular disease will be detected using EKG, ankle brachial index, echocardiography, and electron beam CT scans (in a subset). Patients will be seen at yearly intervals. Renal outcomes include reductions in glomerular filtration rate and level of proteinuria and end-stage kidney disease. Cardiovascular outcomes include clinical events and progression of subclinical cardiovascular disease.

The CRIC study is expected to identify risk factors for chronic kidney disease and cardiovascular disease events among patients with chronic kidney disease and to develop predictive models that will identify high-risk subgroups. Improved recognition of etiological factors will permit development and testing of interventions to reduce the burden of advanced renal failure and cardiovascular morbidity and mortality.