Are you a Physician?

Inquiry Form

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ELIGIBILITY PRE-SCREENER

To see if you may qualify for participation in PHOENIX, please answer the following questions to the best of your ability. This should take approximately 5 minutes. The information you provide will be used ONLY for the purpose of determining your potential eligibility for the study. It will not be sold, shared, or transferred to any party not directly involved in PHOENIX. At the completion of the study (approximately December of 2019), your information will be destroyed.

By continuing, you agree to the privacy policy, and you consent to the use and disclosure of your personal information as described in the privacy policy.

To review the Privacy Policy, click here.









1. Have you been diagnosed with one of the following conditions? (check all that apply)

IgA nephropathy

If yes, did a biopsy confirm your diagnosis of IgA nephropathy?

Type 1 Diabetic CKD (chronic kidney disease)

If yes, were you ≤ 35 when you were diagnosed with Type 1 Diabetes?

FSGS (Focal segmental glomerulosclerosis)

If yes, did a biopsy confirm your diagnosis of FSGS?

ADPKD (Autosomal dominant polycystic kidney disease)

If yes, have you had genetic testing to confirm ADPKD?

Unsure of my diagnosis

Note:

2. Are you between the ages of 18 and 65?

3. Are you willing to participate in at least 10 study visits and 6 phone assessments over 16 weeks?

4. Have you had a kidney transplant?

5. Have you been treated with dialysis or acute kidney injury in the past 12 weeks?

6. Are you currently participating in another research study that requires that you take medication or undergo other treatment for an illness?

7. Have you had a stroke or transient ischemic attack in the last 6 months?

8. Are you being treated for high blood pressure?

9. Are you being treated for diabetes?

10. Have you been diagnosed with left-sided heart disease and/or cardiac disease?


If yes, which heart disease have you been diagnosed with? Please select all that apply to you:

Congenital or acquired valvular disease
Congestive cardiomyopathy
Coronary disease
Prior heart attack
Coronary artery bypass graft (CABG)
Other heart procedure?
Hospitalized due to heart failure
Atrial fibrillation (a-fib)