Cardio-renal epidemiology – Juan-Jesus Carrero's research group

Our research

Our research group focuses on cardio-renal epidemiology and pharmaco-epidemiology. We are a multidisciplinary team with expertise in several fields, including epidemiology, biostatistics, data science and medicine. Our research is based on large population-based and register data, including laboratory values and biopsies. We have several international and national collaborators in academia, health care, and industry. 

We have four main projects ongoing at the moment:

Stockholm  CREAtinine Measurements (SCREAM) project

SCREAM is an electronic health care data extraction of all residents of Stockholm since 2006. SCREAM contains longitudinal electronic health care records for more than 3,5 million people followed for a median of 12 years. For those that have at least one measurement of creatinine or albuminuria, we obtain a large list of laboratory tests. There are more than 2.2 million people with these measurements in the cohort. 

SCREAM is linked to a range of national and regional databases collecting information on among other things primary health care consultations, dispensed medications, and quality registers of cardiovascular diseases, kidney diseases and dementia. 

The principal aims of the project are to assess the burden and consequences of chronic kidney disease (CKD) and the risk-benefit of treatments in people with impaired kidney function. Read more about the project in the separate tab in the menu above. 

Swedish KIdney Pathology (SKIP) cohort  

SKIP cohort is a nationwide cohort linkage of all patients with clinically recognized CKD in Sweden since 1980, including information from kidney biopsies and pathology reports. For every person with CKD, there are 10 matched controls and information from all first relatives. SKIP is linked to a number of national registers on diagnosis, medications, socioeconomic status and professional engagements. 

The main aims of this project is to address the burden of CKD in Sweden, to evaluate health trajectories and lifetime risks of rare kidney diseases, and to analyze hereditability traits by exploring disease occurrence across generations.

Swedish Renal Registry (SRR)

In collaboration with the Nephrology Department at the Karolinska University Hospital, we analyse data from the Swedish Renal Registry, a national quality registry which collects data from patients with chronic kidney disease referred to nephrologist care, from moderate to advanced CKD to kidney replacement therapy. 

The ALMA-CKD trial 

Using the ALMA platform, a software that provides clinical advice to clinicians in primary care in Stockholm, this project tests the impact of electronic decision-support systems to improve the detection and management of people with CKD in primary care. 

This is a pragmatic cluster randomized control trial where 70 primary care centres have been randomized to receive electronic advice to assist in the management of kidney disease. The centres have more than 1500 health care professionals and care for about 750 000 people. The intervention will last for 2 years and data collection is embedded in the SCREAM project. 

Background

The development of simple creatinine-based equations to estimate kidney function has contributed to raise awareness on the epidemics of chronic kidney disease (CKD) to the category of major public health problem. CKD is an important contributor to the burden of non-communicable diseases, leading to poor quality of life and severely reduced life expectancy. CKD also has a substantial impact on societal costs, by increasing per se the need for healthcare services and contributing to work disability. Further, the consequences of CKD are of importance for many other aspects of healthcare, including the incidence of other comorbidities or impairment on the diagnostic accuracy of laboratorial analyses and medical devices dependent on protein or fluid retention by the failing kidneys. Notwithstanding that creatinine is a very common and low-cost assessment in healthcare, systematic screening programs are lacking and, in most societies, the awareness of CKD among both physicians and patients remains very low.

Kidney dysfunction affects, and also is affected by drug metabolism. Many drugs have nephrotoxic effects per se or by forcing hydrophilic drug hyperfiltration in damaged kidneys. Further, significant morbidity is experienced due to medication accumulation and exposure in CKD, commonly leading to adverse events, prolonged length of hospital stay, increased healthcare cost and even death, even when drug clearance is mediated by non-renal mechanisms. Due to low CKD awareness, the risk for inappropriate drug utilization in the community is high, compromising drug safety and effectiveness.