Program Director/Principal Investigator (Last, First, Middle): Rahman, Mahboob Abstract The Chronic Renal Insufficiency Cohort (CRIC) Study enrolled adults with chronic kidney disease to address overarching goals of identifying predictors of progression of kidney disease and clarifying the relationship between kidney dysfunction and cardiovascular disease. The next phase of CRIC extends follow-up through 2023, and adds novel measures that challenge current paradigms of measurement of kidney function and cardiovascular disease. The Case Western Reserve University Clinical Center has the following specific aims: 1) To re-enroll a high percentage of existing participants and obtain center-based assessments 2) maintain high levels of participant retention 3) To identify novel cardiovascular phenotypes using remotely collected data and determine their relationship to clinical outcomes 4) to examine sub-clinical acute declines in kidney function using remotely, collected data and determine their relationship to clinical outcomes 5) to investigate self-reported cardiovascular and renal events and obtain supporting medical records and documentation, 7) To implement effective quality assurance procedures to ensure high-quality measurements, 8) To participate in governance of CRIC 9) To publish findings from CRIC, 10) to conduct approved CRIC ancillary studies, 11) To facilitate novel methods in biostatistics and bioinformatics to analyze complex datasets incorporating a multitude of exposure and outcome variables, 12) To engage investigators at the Case Western Reserve University to assist in local analysis of CRIC data, to conduct ancillary studies, 13) To engage investigators in the broader scientific community to participate in CRIC. We will focus on non-linear trajectories of kidney function, and identify novel cardiovascular phenotypes by integrating physiological parameters and continuous measures of physical activity, and determine their relationship to clinical outcomes. These efforts will allow us to understand the physiology and progression of kidney disease better by incorporating measures taken at home in the patient's usual setting, and may result in novel therapeutic targets for chronic kidney disease.