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impaired capacity; inorganic phosphate; mortality; multidisciplinary; patient population; population based; programs; unpublished works; wasting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）：该提案的基本目标是两个方面：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和后遗症2）促进发展成为独立临床研究者的职业发展。慢性肾脏疾病和甲状腺功能障碍在美国人群中很常见，并且众所周知，在生存中都会对心血管健康产生不利影响。先前的证据表明，患有慢性肾脏疾病和末期肾脏疾病的患者甲状腺疾病的患病率增加，这与肾脏损伤程度成正比。 AIM 1将探索这种关联的潜在机械联系，即是否在肾脏排泄能力降低的情况下暴露于碘化对比介质中是否会促进甲状腺疾病。关于基于数据有限的末期肾脏疾病人群中的高方向和甲状腺功能减退症的方向以及在哪个方向上是否会影响死亡率，并且没有研究末端末期前慢性肾脏疾病的患者中的高甲状体和甲状腺功能减退和死亡率的关联。 AIM 2将探索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背景下放大。 AIM 1将使用哈佛先锋医疗协会所照顾的患者的回顾性队列进行探索，这是一个基于社区的大型多专科组，该群体为多样化的患者人群提供服务，并提供了对合并症，程序和药物数据的全面捕获。 AIM 2将使用第三个国家卫生和营养检查调查数据探索，该调查数据可在美国人口的代表性样本中提供详细的横断面数据和纵向死亡率随访。这项研究将提供有价值的数据，既可以为临床实践提供信息，又指导未来的研究。此外，拟议的研究将在哈佛公共卫生学院的流行病学硕士课程中使用研究设计，数据分析，统计编程和科学写作的租户提供更多经验。正式教学，研究的经验，创建出版物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发展成为独立研究者。此外，这项研究将提供开发和提交指导职业发展奖申请的实际经验和数据，该奖项将在奖励期间结束时制定。 公共卫生相关性：慢性肾脏疾病和甲状腺功能障碍在美国人群中很常见，并且众所周知，两者在生存中都会对心血管健康产生不利影响。先前的证据表明，患有慢性肾脏疾病和末期肾脏疾病的患者中甲状腺疾病的患病率增加。这项研究将探讨1）在肾功能受损的情况下，是否通过暴露于碘化对比培养基来促进甲状腺疾病； 2）在肾功能受损的背景下，甲状腺功能障碍的心血管和全因死亡率是否会放大。