Novel paradigm to improve inflammatory burden in ESRD

改善 ESRD 炎症负担的新范例

基本信息

批准号：
9244137
负责人：
Efthimia Ioannidou
金额：
$ 23.93万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-06-16 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9244137
关键词：
Acute-Phase Proteins Address Agreement Albumins Anti-Inflammatory Agents Anti-inflammatory Behavior Therapy Biological Markers Blood Circulation Blood Vessels Blood specimen C-reactive protein Cardiovascular system Caring Catheters Chronic Chronic Kidney Failure Clinical Comorbidity Connective Tissue Data Dialysis patients Dialysis procedure Disease Disease Outcome Effectiveness of Interventions End stage renal failure Environment Epidemiology Etiology F2-Isoprostanes Fatigue Fistula Goals Guidelines Health Health Services Accessibility Healthy People 2020 Hemodialysis Improve Access Infection Inflammation Inflammatory Inflammatory Response Interleukin-6 Intervention Level of Evidence Link Long-Term Effects Longitudinal Studies Maintenance Malnutrition Measures Mediating Mentored Patient-Oriented Research Career Development Award Microbial Biofilms Modeling Nutritional Oral Oral Health Impact Profile Oral health Outcome Outcome Measure Outpatients Oxidative Stress Patient Recruitments Patient-Focused Outcomes Patients Pattern Periodontal Infection Periodontitis Pharmacology Pilot Projects Population Population Study Prealbumin Prevalence Prevention Preventive Protocols documentation Quality of life Race Reporting Research Severities Source Surveys Therapeutic Time Tooth structure Treatment Effectiveness Work bone loss cytokine effective therapy improved innovation mortality multidisciplinary novel novel strategies nutrition oral care oral infection patient oriented programs response treatment effect

项目摘要

The goal of this multidisciplinary pilot and feasibility proposal is to study the impact of systematic control and prevention of chronic periodontitis, a forgotten comorbidity in End Stage Renal Disease (ESRD). This proposal is significant because it offers a novel approach on the management of the inflammatory burden by targeting oral infections and improving quality of life. Periodontitis, a polymicrobial oral infection, is highly prevalent in ESRD and linked to malnutrition, inflammation and cardiovascular (CVD) mortality. Our preliminary data and other reports have revealed that the magnitude of the inflammatory response to periodontal treatment is similar to the one observed after converting catheter vascular access to fistula in ESRD patients on dialysis. This innovative proposal of repeated and systematic oral health interventions aims to change the paradigm of care by reducing oral and systemic inflammatory burden and improving the well being of this population. Unlike the previously reported episodic interventions, we propose to control periodontal infections in a continuous pattern with frequent maintenance and oral health behavior modifications in a long-term observation period. We have the expertise to implement this model in the outpatient dialysis units in order to improve access to oral care and promise better management of this population characterized by fatigue and physical limitations. We hypothesize that this strategy will improve: a) systemic inflammation and oxidative stress, b) oral health and c) quality of life within the 6-month observation period. We aim to measure true and surrogate outcomes. The first aim will assess the changes in Oral Health Quality of Life (a 14-item survey) and clinical oral parameters at baseline, 2-, 4- and 6-months. The second aim will evaluate the changes in markers of systemic inflammation and oxidative stress in the same time points. Our long-term goal is to identify appropriate and well-perceived oral health guidelines to improve health outcomes in this population and to reduce all cause and CVD mortality (Healthy People 2020 objective).

这个多学科试点和可行性提案的目标是研究系统控制和预防慢性牙周炎，这是一种被遗忘的终末期肾病 (ESRD) 合并症。这个提议意义重大，因为它提供了一种通过靶向治疗炎症负担的新方法口腔感染和改善生活质量。牙周炎是一种多种微生物口腔感染，在 ESRD 与营养不良、炎症和心血管 (CVD) 死亡率有关。我们的初步数据和其他报告显示，牙周治疗的炎症反应程度相似与终末期肾病 (ESRD) 透析患者将导管血管通路转入瘘管后观察到的情况相比。这重复和系统性口腔健康干预的创新提议旨在通过以下方式改变护理模式：减少口腔和全身炎症负担并改善该人群的福祉。与之前报道过间歇性干预措施，我们建议以连续模式控制牙周感染在长期观察期内经常进行维护和口腔健康行为改变。我们有在门诊透析室实施这一模式的专业知识，以改善获得口腔护理的机会有望更好地管理这一以疲劳和身体限制为特征的人群。我们假设该策略将改善：a) 全身炎症和氧化应激，b) 口腔健康，c) 6个月观察期内的生活质量。我们的目标是衡量真实结果和替代结果。第一个目标将评估口腔健康生活质量（一项 14 项调查）和临床口腔参数的变化基线、2 个月、4 个月和 6 个月。第二个目标将评估全身炎症标志物的变化和同一时间点的氧化应激。我们的长期目标是确定合适且被广泛接受的口腔健康指南，以改善该人群的健康结果并降低全因死亡率和心血管疾病死亡率（健康人民 2020 年目标）。