Risk Factors and Sequelae of Thyroid Disease in Patients with Renal Dysfunction

肾功能不全患者甲状腺疾病的危险因素及后遗症

• 批准号: 8395786
• 负责人: Connie Meeyoung Rhee
• 金额: $ 6.47万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8395786
• 关键词: Accounting; Acids; Acute; Adult; Affect; Award; Binding; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Chronic Kidney Failure; Clinical Investigator; Communities; Comorbidity; Contrast Media; Controlled Study; Data; Development; Disease; Dose; End stage renal failure; Epidemiologic Studies; Epidemiology; Erythropoietin; Excretory function; Exposure to; Functional disorder; General Population; Glomerular Filtration Rate; Health; Health Status; Heart Diseases; Hospitalization; Hyperthyroidism; Hypothyroidism; Impaired Renal Function; Incidence; Injury; Intake; Iodides; Iodine; K-Series Research Career Programs; Kidney; Kidney Diseases; Link; Liquid substance; Malnutrition; Massachusetts; Master of Science; Medical; Mentors; Mentorship; Metabolic acidosis; Minority; Modification; National Health and Nutrition Examination Survey; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Population; Prevalence; Proteins; Public Health Schools; Publications; Renal function; Reporting; Research; Research Design; Research Personnel; Residual state; Resistance; Risk; Risk Factors; Sample Size; Sampling; Services; Sodium; Staging; Statistical Data Interpretation; Testing; Thyroid Diseases; Thyroid Gland; Thyroid Hormones; Thyrotropin; Thyroxine; Time; Training; Triiodothyronine; Uncertainty; Uremia; Writing; atherogenesis; base; cardiovascular risk factor; career; clinical practice; cohort; experience; follow-up; hemodynamics; impaired capacity; inorganic phosphate; mortality; multidisciplinary; patient population; population based; programs; unpublished works; wasting

DESCRIPTION (provided by applicant): The fundamental objectives of this proposal are two-fold: 1) to evaluate risk factors for and sequelae of thyroid functional disease in patients with impaired renal function and 2) to promote development towards a career as an independent clinical investigator. Both chronic kidney disease and thyroid dysfunction are common in the US population, and both are known to adversely affect cardiovascular health in survival. Prior evidence indicates that there is an increased prevalence of thyroid disease in patients with chronic kidney disease and end-stage renal disease, which occurs in proportion to the degree of renal injury. Aim 1 will explore one potential mechanistic link for this association, namely whether thyroid disease is promoted by exposure to iodinated contrast media in the setting of decreased renal excretory capacity. There is uncertainty as to whether, and in which direction, hyper- and hypothyroidism may influence mortality in the end-stage renal disease population based on limited data, and there has been no study of the associations of hyper- and hypothyroidism and mortality among patients with pre-end-stage chronic kidney disease. Aim 2 will explore whether the association between thyroid dysfunction and cardiovascular and all-cause mortality is magnified in the context of renal dysfunction. Aim 1 will be explored using a retrospective cohort of patients cared for by Harvard Vanguard Medical Associates, a large, community based multispecialty group that services a diverse patient population and provides comprehensive capture of co-morbidity, procedural, and medication data. Aim 2 will be explored using the Third National Health and Nutrition Examination Survey data which provides detailed cross-sectional data and longitudinal mortality follow-up on a representative sample of the US population. This study will provide valuable data that both informs clinical practice and guides future research. Moreover, the proposed study will provide additional experience in applying tenants of study design, data analysis, statistical programming, and scientific writing, in paralle with didactic training in the Master of Science in Epidemiology program at the Harvard School of Public Health. The combination of formal didactics, experience in the conduct of research, opportunity to create a publication track record, and mentorship provided by the sponsor and collaborators will promote development towards becoming an independent investigator. Furthermore, this research endeavor will provide the practical experience and data necessary for development and submission of a Mentored Career Development Award application, which will be formulated toward the end of the period under award. PUBLIC HEALTH RELEVANCE: Both chronic kidney disease and thyroid dysfunction are common in the US population, and both are known to adversely affect cardiovascular health in survival. Prior evidence indicates that there is an increased prevalence of thyroid disease among patients with chronic kidney disease and end-stage renal disease. This study will explore 1) whether thyroid disease is promoted by exposure to iodinated contrast media in the setting of impaired renal function and 2) whether the cardiovascular and all-cause mortality of thyroid dysfunction are magnified in the context of impaired renal function.

描述（由申请人提供）：该提案的基本目标有两个：1）评估肾功能受损患者甲状腺功能疾病的危险因素和后遗症；2）促进作为独立临床医生的职业发展研究者。慢性肾病和甲状腺功能障碍在美国人群中都很常见，并且众所周知，这两种疾病都会对生存中的心血管健康产生不利影响。先前的证据表明，慢性肾病和终末期肾病患者中甲状腺疾病的患病率有所增加，其发生率与肾损伤程度成正比。目标 1 将探讨这种关联的一个潜在机制联系，即在肾脏排泄能力下降的情况下，暴露于碘造影剂是否会促进甲状腺疾病。基于有限的数据，甲状腺功能亢进和甲状腺功能减退是否以及以何种方向影响终末期肾病人群的死亡率尚不确定，并且尚未研究甲状腺功能亢进和甲状腺功能减退与患者死亡率之间的关系患有终末期慢性肾脏病。目标 2 将探讨甲状腺功能障碍与心血管和全因死亡率之间的关联是否在肾功能障碍的情况下被放大。目标 1 将通过哈佛先锋医学协会 (Harvard Vanguard Medical Associates) 护理的患者回顾性队列进行探索，该协会是一个大型社区多专业小组，为不同的患者群体提供服务，并全面捕获共病、手术和药物数据。将利用第三次全国健康和营养检查调查数据来探索目标 2，该调查提供了对美国人口代表性样本的详细横截面数据和纵向死亡率随访。这项研究将提供有价值的数据，为临床实践提供信息并指导未来的研究。此外，拟议的研究将在应用研究设计、数据分析、统计编程和科学写作方面提供额外的经验，同时提供哈佛大学公共卫生学院流行病学理学硕士项目的教学培训。正式的教学、进行研究的经验、创建发表记录的机会以及赞助商和合作者提供的指导的结合将促进成为一名独立研究者的发展。此外，这项研究工作将为开发和提交指导职业发展奖申请提供必要的实践经验和数据，该申请将在奖励期限结束时制定。 公众健康相关性：慢性肾病和甲状腺功能障碍在美国人群中都很常见，并且众所周知，这两种疾病都会对生存中的心血管健康产生不利影响。先前的证据表明，慢性肾病和终末期肾病患者中甲状腺疾病的患病率有所增加。本研究将探讨 1) 在肾功能受损的情况下，暴露于碘造影剂是否会促进甲状腺疾病；2) 在肾功能受损的情况下，甲状腺功能障碍的心血管和全因死亡率是否会增加。