Clinical, Hemodynamic and Biological Markers of AV Fistula Maturation

动静脉瘘成熟的临床、血流动力学和生物标志物

• 批准号: 7899525
• 负责人: PRABIR ROY-CHAUDHURY
• 金额: $ 34.97万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-11 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7899525
• 关键词: Address; Adverse event; African American; Arteries; Arteriovenous fistula; Biological; Biological Markers; Blood; Blood Vessels; Blood flow; Caliber; Cardiovascular system; Catheters; Clinical; Clinical Markers; Color; Coronary; Data; Data Analyses; Dependence; Development; Dialysis procedure; Dilatation - action; Doppler Ultrasound; Economic Burden; End stage renal failure; Enrollment; Event; Excision; Failure; Female; Fistula; Functional disorder; Future; Goals; Heel; Hemodialysis; Hospitalization; Hyperplasia; Image; Incidence; Individual; Infection; Inflammation; Intervention; Logistic Regressions; Measures; Mediating; Medical; Molecular; Monitor; Morbidity - disease rate; Obesity; Observational Study; Operative Surgical Procedures; Oxidation-Reduction; Oxidative Stress; Pathway interactions; Patients; Pattern; Peripheral Vascular Diseases; Pharmaceutical Preparations; Physical Examination; Physiologic arteriovenous anastomosis; Physiological; Plague; Polytetrafluoroethylene; Population; Postoperative Period; Prevalence; Public Health; Quality of life; Recording of previous events; Regression Analysis; Research Personnel; Risk; Role; Sepsis; Slice; Solutions; Stenosis; Stream; Techniques; Testing; Thrombosis; United States; Veins; Venous; Work; X-Ray Computed Tomography; clinical research site; clopidogrel; cohort; cost; demographics; diabetic patient; economic cost; follow-up; hemodynamics; high risk; indexing; intima media; novel; novel therapeutic intervention; programs; prospective; shear stress; social; success

Arteriovenous (AV) fistula non-maturation is currently a huge clinical problem and a major cause of morbidity and increased costs in the hemodialysis population. Although AV fistulae are the preferred mode of dialysis access they have a very high incidence of maturation failure due to a juxta-anastomotic venous stenosis. This results in multiple endovascular and surgical procedures, together with prolonged catheter dependence (the latter often resulting in sepsis). Despite the magnitude of the clinical problem, however, we currently nave no way of predicting which patients are at high risk of AV fistula non-maturation. The central objective of the current proposal is to identify predictive markers for AV fistula success or failure. In the longer term, we believe that the mechanistic information obtained from this work, will allow for the development of novel therapies to enhance AV fistula maturation. We plan to address our central objective through a prospective, cohort, observational study which will enroll upto 1200 patients who require a new AV fistula over 6-8 clinical sites. In Specific Aim 1, we will assess the impact of clinical markers such as demographics, co-morbidities, vessel size and previous vascular access history on AV fistula maturation and patency. In Specific Aim 2, we will study the relationship between hemodynamic markers such as blood flow, physical examination, the angle of the AV anastomosis and hemodynamic shear stress on AV fistula maturation. Finally, in Specific Aim 3, we will examine the role of biological markers such as oxidative stress and endothelial function on AV fistula maturation. Logistic regression analyses will be performed to identify both individual predictors and groups of predictors for AV fistula non-maturation. We will also use this data to develop clinician friendly "risk scores" for use both prior to surgery and after AV fistula placement. We believe that the current proposal will allow us to stratify patients requiring a new dialysis access into high and low risk groups. Patients in the high risk group would then either be targeted for aggressive follow up and intervention or considered for alternate forms of dialysis access (PTFE grafts). Looking to the future, we also hope that the mechanistic information obtained from this study will allow us to develop novel therapeutic interventions to enhance AV fistula maturation. This could reduce the huge clinical and economic burden currently associated with AV fistula non-maturation. Relevance to Public Health: A better understanding of the factors responsible for AV fistula stenosis could allow us to develop better ways of predicting, monitoring and treating all forms of vascular stenosis including coronary, carotid and peripheral vascular disease.

动静脉（AV）瘘管不饱和目前是一个巨大的临床问题，也是发病率的主要原因 并增加了血液透析人群的成本。尽管AV瘘是首选的透析方式 访问由于近去抗脉冲静脉狭窄，它们的成熟失败发生率很高。 这导致多次血管内和外科手术，以及长时间的导管依赖性 （后者通常导致败血症）。尽管存在临床问题的幅度，但是我们目前 中殿无法预测哪些患者有AV瘘的高风险。 当前建议的核心目的是确定AV瘘成功或失败的预测标记。 从长远来看，我们认为从这项工作中获得的机械信息将允许 开发新的疗法以增强AV瘘的成熟。我们计划解决我们的中心目标 通过一项前瞻性，同类观察性研究，该研究将注册1200名需要新AV的患者 瘘管超过6-8个临床部位。在特定目标1中，我们将评估临床标记的影响，例如 人口统计学，合并症，船只的大小和先前的血管通道历史记录 通畅。在特定目标2中，我们将研究血液动力学标记（例如血流）之间的关系， 体格检查，AV吻合的角度和AV瘘上的血液动力学剪应力 成熟。最后，在特定的目标3中，我们将研究生物标记物（例如氧化应激）的作用 和AV瘘成熟的内皮功能。将进行逻辑回归分析以识别 AV瘘管不饱和的个体预测因子和预测因子组。我们还将使用这些数据来 在手术前和AV瘘放置后开发临床医生友好的“风险评分”。 我们认为，当前的建议将使我们能够将需要新的透析访问的患者分类为高 和低风险群体。然后，高风险组中的患者要么被针对积极的随访 和干预或考虑替代形式的透析通道（PTFE移植物）。展望未来，我们 还希望从这项研究中获得的机械信息将使我们能够开发新颖的治疗性 干预措施以增强AV瘘的成熟。这可以减轻巨大的临床和经济负担 目前与AV瘘管不饱和有关。 与公共卫生有关：更好地了解负责AV瘘狭窄的因素 允许我们发展更好的方法来预测，监测和治疗各种形式的血管狭窄 冠状动脉，颈动脉和周围血管疾病。