Background: Chronic kidney disease (CKD) affects up to 16% of the adult population and is associated with\r\nsignificant morbidity and mortality. People at highest risk from progressive CKD are defined by a sustained decline\r\nin estimated glomerular filtration rate (eGFR) and/or the presence of significant albuminuria/proteinuria and/or\r\nmore advanced CKD. Accurate mapping of the bio-clinical determinants of this group will enable improved risk\r\nstratification and direct the development of better targeted management for people with CKD.\r\nMethods/Design: The Renal Impairment In Secondary Care study is a prospective, observational cohort study,\r\npatients with CKD 4 and 5 or CKD 3 and either accelerated progression and/or proteinuria who are managed in\r\nsecondary care are eligible to participate. Participants undergo a detailed bio-clinical assessment that includes\r\nmeasures of vascular health, periodontal health, quality of life and socio-economic status, clinical assessment and\r\ncollection of samples for biomarker analysis. The assessments take place at baseline, and at six, 18, 36, 60 and 120\r\nmonths; the outcomes of interest include cardiovascular events, progression to end stage kidney disease and death.\r\nDiscussion: The determinants of progression of chronic kidney disease are not fully understood though there are a\r\nnumber of proposed risk factors for progression (both traditional and novel). This study will provide a detailed\r\nbio-clinical phenotype of patients with high-risk chronic kidney disease (high risk of both progression and\r\ncardiovascular events) and will repeatedly assess them over a prolonged follow up period. Recruitment\r\ncommenced in Autumn 2010 and will provide many outputs that will add to the evidence base for progressive\r\nchronic kidney disease.
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