title: The natural history of, and risk factors for, progressive chronic kidney disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol.
abstract: BACKGROUND
  Chronic kidney disease (CKD) affects up to 16% of the adult population and is associated with significant morbidity and mortality. People at highest risk from progressive CKD are defined by a sustained decline in estimated glomerular filtration rate (eGFR) and/or the presence of significant albuminuria/proteinuria and/or more advanced CKD. Accurate mapping of the bio-clinical determinants of this group will enable improved risk stratification and direct the development of better targeted management for people with CKD.
  
  
  METHODS
  The Renal Impairment In Secondary Care study is a prospective, observational cohort study, patients with CKD 4 and 5 or CKD 3 and either accelerated progression and/or proteinuria who are managed in secondary care are eligible to participate. Participants undergo a detailed bio-clinical assessment that includes measures of vascular health, periodontal health, quality of life and socio-economic status, clinical assessment and collection of samples for biomarker analysis. The assessments take place at baseline, and at six, 18, 36, 60 and 120 months; the outcomes of interest include cardiovascular events, progression to end stage kidney disease and death.
  
  
  CONCLUSIONS
  The determinants of progression of chronic kidney disease are not fully understood though there are a number of proposed risk factors for progression (both traditional and novel). This study will provide a detailed bio-clinical phenotype of patients with high-risk chronic kidney disease (high risk of both progression and cardiovascular events) and will repeatedly assess them over a prolonged follow up period. Recruitment commenced in Autumn 2010 and will provide many outputs that will add to the evidence base for progressive chronic kidney disease.
authors.affiliation: Department of Nephrology, University Hospital Birmingham, Birmingham B15 2WB, UK. stephanie.stringer@uhb.nhs.uk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stringer
authors.forename: Praveen
authors.initials: P
authors.lastname: Sharma
authors.forename: Mary
authors.initials: M
authors.lastname: Dutton
authors.forename: Mark
authors.initials: M
authors.lastname: Jesky
authors.forename: Khai
authors.initials: K
authors.lastname: Ng
authors.forename: Okdeep
authors.initials: O
authors.lastname: Kaur
authors.forename: Iain
authors.initials: I
authors.lastname: Chapple
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.forename: Charles
authors.initials: C
authors.lastname: Ferro
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
mesh_terms: D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D063127:Secondary Health Care / Q000379:methods*