Coronary calcification in hemodialysis patients

血液透析患者冠状动脉钙化

基本信息

批准号：
7839055
负责人：
Sylvia E Rosas
金额：
$ 11.02万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-15 至 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7839055
关键词：
Accounting Acute myocardial infarction Arterial Fatty Streak Atherosclerosis Biochemical Biological Markers Blood Vessels Bone Diseases Calcium Cardiovascular Diseases Cessation of life Chronic Chronic Kidney Failure Clinical Cohort Studies DNA Deposition Dialysis patients Dialysis procedure Disease Electron Beam Tomography Enrollment Epidemiology Event Future General Population Genetic Polymorphism Grant Growth Hemodialysis Incidence Individual Inflammation Inflammatory Kidney Kidney Diseases Left Ventricular Hypertrophy Measurement Measures Metabolism Minerals Modeling Oxidative Stress Pathology Pathway interactions Patients Physiologic pulse Play Population Prevalence Process Randomized Clinical Trials Rank-Sum Tests Recruitment Activity Renal Osteodystrophy Risk Risk Factors Role Secondary to Serum Time Vascular calcification Vitamin D arterial stiffness bone bone metabolism bone turnover calcification calcification inhibitor cardiovascular risk factor cohort coronary artery calcification disease characteristic high risk inflammatory marker inhibitor/antagonist insight mortality patient population programs prospective tool

项目摘要

DESCRIPTION (provided by applicant): Patients with chronic kidney disease (CKD) have an increased mortality rate and cardiovascular disease (CVD) accounts for approximately 50% of deaths in these patients. It is an atypical form of atherosclerosis with increased deposition of calcium in the atherosclerotic plaque, thickening of the media and not fully explained by traditional risk factors. Vascular calcification (VC) which leads to arterial stiffness and left ventricular hypertrophy is likely to be a major contributant to the pathology. Recent evidence suggest that a chronic inflammatory state and alterations of bone mineral metabolism and circulating VC inhibitors which are common in dialysis patients may play an important role in the vascular calcification process. We are responding to PA-06-148 Pilot and Feasibility Program Related to the Kidney whose objective is to use epidemiological and biochemical approaches to identify new, non-traditional risk factors for CVD in patients with CKD. Coronary artery calcification (CAC) is common in this population and has been associated with increased mortality. Pulse wave velocity has also been found to be independently associated with mortality in this patients. These two non-invasive measurements will be able to provide an assessment of the degree of vascular calcification and compliance in each subject. We hypothesize that in individuals with the highest levels of inflammatory and alteration of bone metabolism, CAC will be more prevalent and progress more rapidly in a 12-month period than in those with normal inflammatory state and bone metabolism. We propose to enroll a cohort of 125 incident asymptomatic dialysis patients and obtain measurements of CAC and PWV prospectively. Our main tool for analysis will be Wilcoxon rank-sum test and standard mixed effects growth curve models. The study findings will aid in identifying risk factors whose risk profile we can alter in future randomized clinical trials. In addition, it will provide insight on whether current clinical therapies are increasing the burden of calcification in our dialysis population.

描述（由申请人提供）：慢性肾病 (CKD) 患者的死亡率增加，心血管疾病 (CVD) 约占这些患者死亡的 50%。它是一种非典型的动脉粥样硬化形式，动脉粥样硬化斑块中钙沉积增加，中膜增厚，传统危险因素无法完全解释。导致动脉僵硬和左心室肥厚的血管钙化（VC）可能是病理学的主要原因。最近的证据表明，透析患者中常见的慢性炎症状态、骨矿物质代谢和循环 VC 抑制剂的改变可能在血管钙化过程中发挥重要作用。我们正在响应 PA-06-148 与肾脏相关的试点和可行性计划，其目标是使用流行病学和生化方法来确定 CKD 患者 CVD 的新的非传统危险因素。冠状动脉钙化（CAC）在该人群中很常见，并且与死亡率增加有关。还发现脉搏波速度与该患者的死亡率独立相关。这两种非侵入性测量将能够评估每个受试者的血管钙化程度和顺应性。我们假设，在炎症和骨代谢改变水平最高的个体中，CAC 在 12 个月内比炎症状态和骨代谢正常的个体更普遍且进展更快。我们建议招募 125 名无症状透析患者组成的队列，并前瞻性地获取 CAC 和 PWV 测量结果。我们的主要分析工具是 Wilcoxon 秩和检验和标准混合效应增长曲线模型。研究结果将有助于确定风险因素，我们可以在未来的随机临床试验中改变其风险状况。此外，它将提供有关当前临床治疗是否增加透析人群钙化负担的见解。