Projectdetails

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Population screening for increased albuminuria among the Dutch population to detect cardiovascular and chronic renal disease in an early stage

Keywords:
cardiovascular disease Chronic Kidney Disease population screening

Researchers:
Prof. dr. R.T. Gansevoort
dr. L.M. Kieneker

Nature of the research:
Analyses of data from the NierCheck study and also collection of new follow-up data from general practitioners and pharmacies.

Fields of study:
GP medicine internal medicine nephrology

Background / introduction
Chronic kidney disease (CKD) is a worldwide major public health problem that is associated with an increased incidence of kidney failure and cardiovascular morbidity and mortality, which causes high costs for society. Symptoms of CKD are aspecific and usually start to appear only when kidney function drops to below 30%. At that time preventive measures will have only limited efficacy. Elevated albuminuria has increasingly been recognized as an early marker of kidney damage, and is also associated with high blood pressure, diabetes, and high cholesterol levels, which are all important risk factors for progressive CKD and cardiovascular disease (CVD). Importantly, it has been shown that in the Dutch population, the prevalence of yet undiagnosed risk factors is considerably higher than the prevalence of known risk factors. Population screening for albuminuria could therefore detect a considerable number of subjects with yet unknown risk factors for progressive CKD and CVD who can benefit of early intervention. In the NierCheck study, 15.000 men and women aged 45-80 years are invited to participate in such a screening for albuminuria. In case of elevated albuminuria, the participant is referred for further screening for CKD and CVD risk factors (hypertension, diabetes, hypercholesterolemia, impaired kidney function) at a central screening facility. Depending on the results of the elaborate screening, subjects are referred to their general practitioner (GP) to be prescribed lifestyle measures and/or medical intervention. However, it is yet unknown whether these participants afterwards visited their GP, and whether the GP initiated or changed treatment. If these latter steps are not taken correctly, population screening in this way might not be effective and other care models (e.g. follow-up also in screening facility) should be considered.
Research question / problem definition
With the NierCheck study, we have identified patients high at risk for developing chronic kidney disease and cardiovascular disease. These patients were referred to their general practitioner. Population screening can only be effective when interventions (lifestyle and/or medication) are started in these patients. Therefore, the following research questions should be answered:
1) Did the identified high-risk patients who were referred to their GP for treatment, actually visited their GP?
2) Did the GP's of the referred high-risk patients started or changed treatment of the patient?
3) Were the initiated interventions according to the prevailing guidelines?
4) Should other care models (i.e. central screening facility) be considered for the follow-up of population screening or is the current care model (treatment at GP's) sufficient?
Workplan
Collection of GP and pharmacy data from the identified high-risk patients to examine whether patients visited their GP after the referral, and whether the GP started or changed treatment has started/changed.

What we can offer:
- Data collection, data entry and analyses of follow-up data of identified high-risk patients
- Possibility for investigating related research questions in your own field of interest
- Development of your writing and statistical skills
- Development of your presentation skills by presenting data on international meetings
- Possibility to publish in international peer-reviewed scientific journals

We are looking for an independent student with:
- Coordination and cooperation skills
- Clear in communication
- Writing skills are a pre
- Mastering the Dutch and English language
References
1. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, Hostetter TH. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 2005;16:180-8.
2. Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, Fox CS, Gansevoort RT, Heerspink HJL, Jardine M, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017;390:1888-917.
3. James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet 2010;375:1296-309.
4. Hillege HL, Janssen WM, Bak AA, Diercks GF, Grobbee DE, Crijns HJ, Van Gilst WH, De Zeeuw D, De Jong PE, Prevend Study Group. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001;249:519-26.
5. Arnlov J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, Benjamin EJ, D'Agostino RB, Vasan RS. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005;112:969-75.
6. Verhave JC, Gansevoort RT, Hillege HL, Bakker SJ, De Zeeuw D, de Jong PE, PREVEND Study Group. An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population. Kidney Int Suppl 2004;(92):S18-21.
7. Ozyilmaz A, Bakker SJ, de Zeeuw D, de Jong PE, Gansevoort RT, PREVEND Study Group. Selection on albuminuria enhances the efficacy of screening for cardiovascular risk factors. Nephrol Dial Transplant 2010;25:3560-8.
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