Abstract
Project: A cohort of CKD patients with high risk for cardiovascular events or renal disease progression multicenter study (CORE-CKD Thailand) Phase 2: Outcomes and Cost-Effectiveness Extension Study Introduction: Chronic kidney disease (CKD) has effects on quality of life, high cost of care, increases the risk of cardiovascular disease, renal disease progression and other complications. Both traditional factors including hypertension and non-traditional factors including arterial stiffness, salt and water retention, genetic factors and other biological molecules contribute to the cardiac complications and renal decline. Methods: CORE-CKD (Thailand) Phase 2 is multicenter, hospital-based, non-interventional prospective cohort which follow patients with CKD stage 1-4 enrolled in Phase 1. CORE-CKD phase 2 study comprises of 3 objectives: Evaluate risks for 1) cardiovascular disease and 2) renal decline over 3-5 years and 3) Economic impact of CKD by evaluating direct and indirect cost and cot-effectiveness of various treatment. This study will also collect data from elderly patients, patients with on hemodialysis or peritoneal dialysis for comparisons with CKD stage 1-4; Aim 3 Collect DNA, blood and urine into biobank for studies in biomarker studies. Results: 1,409 patients have been enrolled from 21 centers covering all regions of Thailand. Over 1000 samples have been stored in biobank. This report will focus on cross-sectional analysis of the baseline data 1) Control of blood pressure in Thai CKD subjects in comparison to International cohort. Among Thai CKD patients, the proportion above target BP were: <130/80 mmHg 73.1%, and <140/90 mmHg 45.5%. Just over 50% were on angiotensin receptor blockers or ACE inhibitors. 2) Relationship of arterial stiffness measured by cardio-ankle vascular index (CAVI) and abnormal cardiac contraction by echocardiography in the development heart failure in CKD. Both mean CAVI and Ventricular-arterial Coupling (VA coupling) was significantly higher in CKD patients with heart failure compared with patient without heart failure. 3) Researchers currently evaluating relationship of psychosocial impact, risks of CVD, relationship of CAVI and pelvic vascular calcification, CKD staging using creatinine or cystatin C, 24 hr. urine sodium intake, prevalence of anemia and other complications, development of metabolomics for identification of renal disease progression and economic impact in CKD patients. Conclusions: CKD patients have high prevalence of many risk factors. Arterial stiffness and abnormal cardiac contraction is associated with heart failure in CKD. The treatment of hypertension in still inadequate. This knowledge will be useful to make strategies to achieve control of various risk factors. This is the first year of a three year project. In the next 2 years data analyses on other parameters will be more complete and more information would be available on risks for CVD, kidney disease progression and economic burden of CKD in Thailand.
