Frequency domain shortwave infrared spectroscopy (FD-SWIRS) for volume status monitoring during hemodialysis in end stage kidney disease

频域短波红外光谱 (FD-SWIRS) 用于终末期肾病血液透析期间容量状态监测

• 批准号: 10432546
• 负责人: Vipul C Chitalia
• 金额: $ 22.4万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10432546
• 关键词: Academic Medical Centers; Address; American; Area; Benchmarking; Binding; Blood; Body Weight Changes; Boston; Cardiovascular system; Cause of Death; Chronic Kidney Failure; Clinical; Clinical Research; Country; Data; Dialysis procedure; Diffuse; Edema; End stage renal failure; Excision; Fat emulsion; Fatigue; Feasibility Studies; Fluid overload; Frequencies; Funding; Health; Healthcare; Heart failure; Hemodialysis; Homeostasis; Hour; Hypertension; Hypotension; Kidney; Kidney Transplantation; Label; Lateral; Leg; Lighting; Lipids; Liquid substance; Location; Measurement; Methods; Modeling; Monitor; Muscle Cramp; Nausea and Vomiting; Nephrology; Optics; Pain; Patients; Performance; Phase; Physicians; Pilot Projects; Population; Process; Property; Proteins; Quality of life; Renal function; Research Priority; Scientist; Short Waves; Signal Transduction; Source; Spectrum Analysis; Speed; Symptoms; System; Techniques; Technology; Testing; Time; Tissues; Titrations; Toxin; Ultrafiltration; Variant; Water; Weight; absorption; digital; experimental study; extracellular; healthy volunteer; indexing; infrared spectroscopy; mortality; new technology; novel; premature; prevent; solute; standard of care

PROJECT SUMMARY Chronic kidney disease (CKD), or the gradual loss of kidney function, is the ninth leading cause of death in the US and poses an astronomical healthcare burden. CKD eventually leads to end-stage kidney disease (ESKD), requiring hemodialysis treatment (HD) or kidney transplant for survival. HD is the process of removing excess water, solutes, and toxins from the blood in patients, as kidneys can no longer perform these natural functions. In 2017 there were 746,557 Americans with ESKD, and 70% of these were on HD. Patients with ESKD accumulate fluid in between HD sessions, whose removal is a quintessential function of HD. Insufficient fluid removal on HD results in volume overload contributing to hypertension, heart failure and eventual cardiovascular mortality. Excess fluid removal results in hypotension, muscle cramps and compromises vitality after HD. Thus, it is critical to maintain dry weight, or weight without excess fluid in CKD patients. Despite the central importance of maintaining volume homeostasis in patients with ESKD, there are currently no quantitative standards for monitoring volume status of patients undergoing HD. The volume assessment of patients on HD remains the most challenging aspect of nephrology practice. This project aims to develop frequency-domain shortwave infrared spectroscopy (FD-SWIRS) for the unmet clinical need of HD volume status monitoring in patients with ESKD. The SWIR wavelength band (also called NIR II) is more sensitive to water and lipids compared to the visible or NIR bands, and can potentially provide deeper tissue measurements. FD-SWIRS will provide measurements of the absolute absorption and reduced scattering coefficients over a broad wavelength range (900-1310 nm). FD-SWIRS would represent a new technology, and to the best of our knowledge, no similar technologies have been used for HD monitoring. FD-SWIRS will provide three unique sources of label-free contrast for HD monitoring: 1) tissue molar water concentration changes calculated from broadband (900-1310 nm) absorption coefficients (µa), 2) broadband reduced scattering (µs′), and 3) bound water index (BWI), which utilizes subtle spectral shifts related to the binding of water molecules to proteins in tissue. We hypothesize that that these sources of contrast will accurately reveal volume status and provide a non-invasive indicator of extracellular versus intracellular water, which has been shown to be important for volume assessment. We will first develop an FD-SWIRS system and validate performance through rigorous system testing. A multi-layer inverse model will be developed to extract deep tissue optical properties. We will then perform pre, post and intradialytic measurements of FD-SWIRS in 50 dialysis sessions with the hypothesis that there will be alteration in FD-SWIRS signal between pre and post-HD time points. In addition, we posit that FD-SWIRS signal will change throughout dialysis session and may coincide or precede the dialysis-related complications. Successful completion of this pilot project will be the first to apply a novel technique FD-SWIRS to an important clinical problem in patients on HD, and will guide subsequent R01-scale funding.

项目摘要 慢性肾脏疾病（CKD）或肾功能的年级丧失是第九个主要死亡原因 我们构成了天文保健负担。 CKD有时会导致末期肾脏疾病（ESKD）， 需要血液透析治疗（HD）或肾脏移植以生存。高清是消除多余的过程 患者血液中的水，溶质和毒素，因为肾脏无法再执行这些自然功能。 2017年，有746,557名具有ESKD的美国人，其中70％是高清的。 ESKD患者 在HD会话之间积聚流体，其去除是HD的典型函数。流体不足 删除高清导致体积超负荷导致高血压，心力衰竭和最终心血管 死亡。过量的液体去除会导致低血压，肌肉痉挛并损害HD后活力。那， 在CKD患者中保持干重或没有过量的液体至关重要。尽管至关重要 维持ESKD患者的体积体内稳态，目前尚无定量标准 监测正在进行高清的患者的体积状态。高清患者的体积评估仍然是 肾脏学实践的最挑战方面。该项目旨在开发频域短波 红外光谱（FD-SWIRS），用于患者患者的HD体积状态监测未满足的临床需求 ESKD。与与水相比 可见或NIR带，并可能提供更深的组织测量。 FD-SWIRS将提供 在广泛波长范围内的绝对绝对损耗和减少散射系数的测量 （900-1310 nm）。 FD-SWIRS将代表一项新技术，据我们所知，没有类似的 技术已用于高清监测。 FD-SWIRS将提供三种独特的无标签来源 高清监测的对比：1）根据宽带计算出的组织摩尔水浓度变化（900-1310 NM）吸收系数（µA），2）宽带减少散射（µS'）和3）结合水指数（BWI） 利用与水分子与组织中蛋白质的结合有关的微妙光谱变化。我们假设这一点 这些对比来源将准确揭示数量状态，并提供无创的指标 细胞外水与细胞内水，这对于体积评估很重要。我们将 首先开发FD-SWIRS系统，并通过严格的系统测试来验证性能。多层 逆模型将开发以提取深组织光学性能。然后，我们将执行pre，post和 在50个透析课程中对FD-SWIRS的透析测量，并假设将发生变化 在前HD时间点和后时间点之间的FD-SWIRS信号中。此外，我们海报说FD-SWIRS信号将 整个透析过程中的变化，可能会重合或在与透析相关并发症之前。成功的 该试点项目的完成将是第一个将新型技术FD-SWIRS应用于重要临床 HD患者的问题，并将指导随后的R01规模资金。