Download Multicenter database of clinical course of CKD patients

<Bioinformatics Term Project Proposal>
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