VASCULAR ABNORMALITIES IN CRD

CRD 中的血管异常

• 批准号: 7374489
• 负责人: MARK M. MITSNEFES
• 金额: $ 0.77万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7374489
• 关键词: VASCULAR; ABNORMALITIES; CRD

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Project 1: Cardiac disease in children with chronic renal failure IK23 HL69296-01A1 Cardiovascular disease (CVD) is the leading cause of death in adult and pediatric patients with end-stage renal disease (ESRD). Cardiovascular changes are frequently present in children with advanced renal failure. Left ventricular hypertrophy (LVH) is already highly prevalent in children at the initiation of chronic dialysis therapy, and remains prevalent during long-term dialysis and after renal transplantation. Exactly when these abnormalities first appear in the course of renal failure is not known. The fact that LVH is already prevalent at the time of entry to chronic dialysis strongly indicates that LV abnormalities develop during early chronic renal insufficiency (CRI). We also postulate that in addition to LVH, pediatric patients with CRI develop abnormalities of LV function as well as vascular abnormalities. The hypothesis underlying the proposal is that cardiovascular changes occur in children with relatively mild CRI, and progress as end-stage disease approaches. To test this concept, we will assess cardiac and vascular abnormalities and identify risk factors for these abnormalities in pediatric patients with CRI. Specifically, we will examine: 1. Cardiac structure by evaluation of LV mass, LV geometry; 2. LV systolic and diastolic function using rest and stress echocardiography; 3. Vascular structure by assessment of carotid artery intima-media thickness (IMT); 4. Vascular function by assesment of endothelium-mediated vasodilatation of the brachial artery using high-resolution B-mode ultrasound. In addition, we will determine the role of blood pressure by ambulatory blood pressure monitoring, anemia, etiology and rate of progression of CRI, hyperlipidemia and hyperhomocysteinemia as possible risk factors for cardiac or vascular abnormalities and assess the changes of cardiovascular structure and function by repeating the evaluation 2 years after initial examination. Evaluation of the relationships between LV structure, LV function, carotid IMT and endothelial function will help to gather the important information needed for future mechanistic studies of development of cardiovascular disease in children with CRI. By understanding the risk factors and temporal evolution by which cardiovascular abnormalities develop in these patients, we may then be able to develop and test preventive interventions. It is possible that mild-to-moderate CRI is the optimal time during which identification of modifiable risk factors and early intervention might lead to elective treatment and even to prevention of cardiac disease over the long term. Thus, the long-term goal will be to decrease the incidence and prevalence of cardiovascular disease in young adults who developed chronic renal disease during childhood. Project 2: Cardiovascular abnormalities in children and adolescents with renal transplantation AHA #0160214B Our research is aimed at understanding how cardiovascular disease develops and progresses in children and adolescents with renal transplantation. In particular, we are trying to show that even after successful renal transplantation these patients present with abnormalities of heart structure and function as well as abnormalities of large blood vessels. Recently we showed high frequency of left ventricular hypertrophy (increased size of the left pumping chamber of the heart) in children on chronic dialysis and after transplantation. Since some of the risk factors and mechanisms for the development of heart hypertrophy and blood vessels injury are similar, it is likely that vascular damage such as increased thickness and stiffness of the blood vessel wall are present in children after renal transplantation. We will evaluate cardiovascular structure and function by applying non-invasive methodologies such as rest and stress echocardiography (ultrasound of the heart) as well as high resolution B-mode ultrasound of the blood vessels. We will also evaluate blood pressure using ambulatory blood pressure monitoring, anemia, lipid abnormalities and abnormal blood viscosity as possible risk factors for cardiac or vascular abnormalities. It is hoped that the mechanisms by which cardiovascular disease develops in children and adolescents with renal transplantation will be better understood as a result of this proposal.

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构适用于该中心，这不一定是调查员的机构。项目1：患有慢性肾衰竭儿童IK23 HL69296-01A1心血管疾病（CVD）的心脏病是成人和儿科终末期肾脏疾病（ESRD）的主要死亡原因。晚期肾衰竭儿童经常存在心血管变化。左心室肥大（LVH）在慢性透析治疗开始时的儿童中已经很普遍，并且在长期透析和肾脏移植后仍然很普遍。确切地说，这些异常首先出现在肾衰竭过程中时，尚不清楚。 LVH在进入慢性透析时已经普遍存在的事实强烈表明，早期慢性肾功能不全（CRI）期间LV异常出现。我们还假设，除LVH外，患有CRI的儿科患者会出现LV功能异常以及血管异常。该提案的基本假设是，患有相对温和的CRI的儿童发生心血管变化，并且作为终阶段疾病的进展。为了测试这一概念，我们将评估儿科患者中这些异常的心脏和血管异常，并确定这些异常的危险因素。具体而言，我们将通过评估LV质量，LV几何形状来检查：1。心脏结构； 2。使用休息和应力超声心动图的LV收缩和舒张功能； 3。通过评估颈动脉内膜厚度（IMT）来评估血管结构； 4。通过使用高分辨率B模式超声检查内皮介导的臂动脉血管舒张的血管功能。此外，我们将通过卧床血压监测，贫血，病因和CRI，高脂血症和多型性半胱氨酸血症的进展率来确定血压的作用，作为心脏或血管异常的可能风险因素，并评估心血管结构的变化以及在初步检查后重复评估2年后的功能。评估LV结构，LV功能，颈动脉IMT和内皮功能之间的关系，将有助于收集CRI儿童心血管疾病发展的未来机械性研究所需的重要信息。通过了解这些患者心血管异常的危险因素和时间进化，然后我们可以开发和测试预防性干预措施。轻度到中度的CRI可能是最佳的时间，在这种情况下，长期鉴定可改变的危险因素和早期干预可能会导致选择性治疗，甚至可以长期预防心脏病。因此，长期目标是减少儿童期在慢性肾脏疾病的年轻人中降低心血管疾病的发病率和患病率。 项目2：肾移植儿童和青少年的心血管异常AHA＃0160214B我们的研究旨在了解心血管疾病如何在肾移植的儿童和青少年中发展和进步。特别是，我们试图表明，即使成功肾移植后，这些患者的心脏结构和功能异常以及大血管异常。最近，我们显示了慢性透析和移植后儿童的左心室肥大（心脏左泵室的大小增加）的高频。由于一些危险因素和心脏肥大和血管损伤的机制相似，因此肾移植后儿童中可能存在血管损伤，例如增加厚度和血管壁的僵硬。我们将通过应用非侵入性方法（例如心脏超声）以及血管的高分辨率B模式超声来评估心血管结构和功能。我们还将使用门诊血压监测，贫血，脂质异常和异常血液粘度作为心脏或血管异常的危险因素评估血压。希望通过该提议，可以更好地理解肾移植儿童和青少年心血管疾病的机制。