Chronic Kidney Disease
The prevalence and
the incidence of the end-stage renal disease (ESRD) are extremely high in
Taiwan.
More than 50,000 patients are under renal replacement
therapy in the year 2008. The disease had not only caused a significant impact
in personal life, but also a great burden on social security and government-run
health insurance. However, despite this high prevalence, the awareness of
chronic kidney disease (CKD) in general population remains low. The patients
always come out too late for the intervention to slow down the progression of
renal failure. Despite integrative care and timely referral of CKD patients, the
incidence of CKD remains high. Family members of CKD patients are at high risk
to develop progressive CKD. However, only a certain percentage of patients
progressed into renal failure. Genetic and environmental factors are thought to
play roles in the development and progression of the CKD.
Emerging evidences
suggest several putative biomarkers associated with CKD progression. Chronic
inflammation, endothelial dysfunction, direct organ-toxicity (myocardial or
renal necrosis), and remodeling/fibrosis represent the pivotal pathogenic
mechanism of disease progression in CKD patients. The most promising biomarkers
associated with CKD progression included protein bound uremic toxins, Neutrophil
gelatinase-associated lipocalin (NGAL), visfatin, adiponectin, leptin and
Liver-type fatty acid-binding protein (L-FABP).
The integrative project
includes 5 sub-projects: “Biomarker and multidisciplinary predialysis education
in CKD patients”, “Role of Insulin resistance in progression of CKD”, “Study of
association between the regulatory polymorphisms in organic anion transportor
and CKD”, “Chronic kidney disease and Immune function dysregulation” and “left
ventricle function and coronary artery flow reserve in CKD”. The major purpose
of the sub-project 1 is the early screen of CKD, follow-up of progression and
establishment of relationship of biomarker with the outcome of CKD patients. The
project will be last for 3 years. The aim of the present study is to establish
the relationship of potential biomarker of the outcome of CKD patients and to
evaluate the effectiveness of multidisciplinary predialysis education (MPE) on
the serum level of these biomarkers. We will prospectively evaluate the effect
of multidisciplinary predialysis education (MPE) on important major endpoint of
CKD patients (i.e., decrement of eGFR by 50%, urine protein to creatinine ratio
> 0.1, progression to ESRD or all-cause mortality). Then using a nested
case-control design to establish the relationship of serum level of potential
biomarker (protein bound uremic toxins, hs-CRP, NGAL, adiponectin, leptin,
visfatin and L-FABP) with outcome of these patients.
The study will collect
the characteristic demographic epidemiological data and find out risk factors
for CKD progression of this geographic area, and establish relationship of
progression with these biomarkers. The project will provide new insight and
understanding of mechanism of CKD progression and effectiveness of MPE on serum
levels of these biomarkers.
