Multicenter database of clinical course of CKD patients Internal Medicine Jang Hye Ryoun

Chronic kidney disease Staging of CKD (chronic kidney disease) stage 1 ; GFR 90 mL/min stage 2 ; GFR 60~89 mL/min stage 3 ; GFR 30~59 mL/min stage 4 ; GFR 15~29 mL/min stage 5 ; GFR < 15 mL/min Inclusion criteria - CKD stage 2~5 - non-diabetic renal disease

CKD & cardiovascular risk CKD - independent risk factor of CVD Non-traditional risk factors - type of CKD- calcium and phosphorus - degree of GFR- oxidative stress - proteinuria- uremic toxins - inflammation- renin-angiotensin - malnutrition - anemia

Reversed epidemiology in ESRD patients A low (and not a high) total serum creatinine is associated with poor ESRD outcome (Lowrie, 1990) A low (and not a high) BMI or weight for height is associated with increased morbidity and mortality among ESRD patients (Kopple et al,1999; Fleischmann et al,1999) A low (and not a high) total serum cholesterol is associated with poor ESRD outcome (Lowrie, 1990) A low blood pressure may indicate poor outcome in ESRD (Zager, 1998) A low serum homocysteine may be associated with poor survival (Suliman et al, 2000; Wrone, 2001)

Causes of reversed epidemiology Survival bias (selection bias) Time discrepancy of competitive risk factors Impact of malnutrition

ACE gene Angiotensin-converting enzyme gene on chromosome 6 deletion allele (D) in the ACE gene increases serum and tissue ACE levels association with risk of progression of IgA nephropathy or chronic kidney disease DD genotype

Proposal Multicenter database of CKD clinical course Microarray detection of genes responsible for rapid renal function deterioration or cardiovascular disease

Methods Multicenter database of CKD clinical course - Treatment protocol - Database construction Microarray - in patients undergoing renal biopsy - searching for potentially responsible genes