Chronic kidney disease: determinants of progression and cardiovascular risk: a cohort study in a brazilian population

Abstract

Chronic kidney disease has become an important Public Health issue in most developed and developing countries, with increasing incidence and prevalence rates. The cost associated with chronic kidney disease patients is very high, derived from renal replacement therapy and the cost associated with the high cardiovascular risk of this population. Primary and secondary preventive measures are imperative. In this sense, the comprehension of pathological mechanisms associated with CKD progression and to the determination of the cardiovascular risk in this population is an important area of research. Disturbances of mineral metabolism (phosphorus, calcium, vitamin D, PTH and other phosphatonins, such as FGF-23) emerge as an important link. Beyond their role as possible biomarkers of the risk of CKD progression and of cardiovascular events, these molecules are possibly causally involved in the pathogenesis of CKD and atherosclerosis. This project aims the formation of a cohort of CKD Brazilian patients. Recently, the "Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)" included 15.102 participants from the general population in a cohort study aiming to evaluate cardiovascular disease and diabetes. The present study is very much related to ELSA-Brasil, with the particularity of creating a cohort of patients already with chronic kidney disease. It will use ELSA-Brasil infra-structure in Sao Paulo for recruitment, baseline evaluation and follow-up. Baseline variables will be focused on mineral metabolism, classical cardiovascular risk factors and pre-clinical measures of atherosclerosis such as calcium score, carotid intimal media thickness, retinography, and pulse wave velocity. The cohort will be monitored in relation to incident death, fatal and non-fatal cardiovascular events, initiation of dialysis or transplantation, and progression of chronic kidney disease. The solicitation of this grant is related to the creation of this cohort, the recruitment of patients and measurements of baseline variables. (AU)