Frequency domain shortwave infrared spectroscopy (FD-SWIRS) for volume status monitoring during hemodialysis in end stage kidney disease

频域短波红外光谱 (FD-SWIRS) 用于终末期肾病血液透析期间容量状态监测

• 批准号: 10432546
• 负责人: Vipul C Chitalia
• 金额: $ 22.4万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10432546
• 关键词: Academic Medical Centers; Address; American; Area; Benchmarking; Binding; Blood; Body Weight Changes; Boston; Cardiovascular system; Cause of Death; Chronic Kidney Failure; Clinical; Clinical Research; Country; Data; Dialysis procedure; Diffuse; Edema; End stage renal failure; Excision; Fat emulsion; Fatigue; Feasibility Studies; Fluid overload; Frequencies; Funding; Health; Healthcare; Heart failure; Hemodialysis; Homeostasis; Hour; Hypertension; Hypotension; Kidney; Kidney Transplantation; Label; Lateral; Leg; Lighting; Lipids; Liquid substance; Location; Measurement; Methods; Modeling; Monitor; Muscle Cramp; Nausea and Vomiting; Nephrology; Optics; Pain; Patients; Performance; Phase; Physicians; Pilot Projects; Population; Process; Property; Proteins; Quality of life; Renal function; Research Priority; Scientist; Short Waves; Signal Transduction; Source; Spectrum Analysis; Speed; Symptoms; System; Techniques; Technology; Testing; Time; Tissues; Titrations; Toxin; Ultrafiltration; Variant; Water; Weight; absorption; digital; experimental study; extracellular; healthy volunteer; indexing; infrared spectroscopy; mortality; new technology; novel; premature; prevent; solute; standard of care

PROJECT SUMMARY Chronic kidney disease (CKD), or the gradual loss of kidney function, is the ninth leading cause of death in the US and poses an astronomical healthcare burden. CKD eventually leads to end-stage kidney disease (ESKD), requiring hemodialysis treatment (HD) or kidney transplant for survival. HD is the process of removing excess water, solutes, and toxins from the blood in patients, as kidneys can no longer perform these natural functions. In 2017 there were 746,557 Americans with ESKD, and 70% of these were on HD. Patients with ESKD accumulate fluid in between HD sessions, whose removal is a quintessential function of HD. Insufficient fluid removal on HD results in volume overload contributing to hypertension, heart failure and eventual cardiovascular mortality. Excess fluid removal results in hypotension, muscle cramps and compromises vitality after HD. Thus, it is critical to maintain dry weight, or weight without excess fluid in CKD patients. Despite the central importance of maintaining volume homeostasis in patients with ESKD, there are currently no quantitative standards for monitoring volume status of patients undergoing HD. The volume assessment of patients on HD remains the most challenging aspect of nephrology practice. This project aims to develop frequency-domain shortwave infrared spectroscopy (FD-SWIRS) for the unmet clinical need of HD volume status monitoring in patients with ESKD. The SWIR wavelength band (also called NIR II) is more sensitive to water and lipids compared to the visible or NIR bands, and can potentially provide deeper tissue measurements. FD-SWIRS will provide measurements of the absolute absorption and reduced scattering coefficients over a broad wavelength range (900-1310 nm). FD-SWIRS would represent a new technology, and to the best of our knowledge, no similar technologies have been used for HD monitoring. FD-SWIRS will provide three unique sources of label-free contrast for HD monitoring: 1) tissue molar water concentration changes calculated from broadband (900-1310 nm) absorption coefficients (µa), 2) broadband reduced scattering (µs′), and 3) bound water index (BWI), which utilizes subtle spectral shifts related to the binding of water molecules to proteins in tissue. We hypothesize that that these sources of contrast will accurately reveal volume status and provide a non-invasive indicator of extracellular versus intracellular water, which has been shown to be important for volume assessment. We will first develop an FD-SWIRS system and validate performance through rigorous system testing. A multi-layer inverse model will be developed to extract deep tissue optical properties. We will then perform pre, post and intradialytic measurements of FD-SWIRS in 50 dialysis sessions with the hypothesis that there will be alteration in FD-SWIRS signal between pre and post-HD time points. In addition, we posit that FD-SWIRS signal will change throughout dialysis session and may coincide or precede the dialysis-related complications. Successful completion of this pilot project will be the first to apply a novel technique FD-SWIRS to an important clinical problem in patients on HD, and will guide subsequent R01-scale funding.

项目摘要 慢性肾脏疾病（CKD），或肾功能的逐渐丧失，是世界上第九大死亡原因。 美国，并构成了天文数字的医疗负担。CKD最终导致终末期肾病（ESKD）， 需要血液透析治疗（HD）或肾移植才能生存。HD是去除多余的 水，溶质和毒素从病人的血液，因为肾脏不能再执行这些自然功能。 2017年，有746，557名美国人患有ESKD，其中70%是HD。ESKD患者 血液透析治疗之间的液体积聚，清除液体是血液透析的基本功能。不充分流体 在HD时移除导致容量超负荷，导致高血压、心力衰竭和最终的心血管疾病 mortality.血液透析后，过量液体排出导致低血压、肌肉痉挛和活力受损。因此，在本发明中， 在CKD患者中保持干重或没有过量液体重量是至关重要的。尽管至关重要， 维持ESKD患者的容量稳态，目前没有定量标准， 监测接受HD的患者的容量状态。HD患者的容量评估仍然是 最具挑战性的方面。本项目旨在开发频域短波 红外光谱（FD-SWIRS）用于未满足的HD容量状态监测患者的临床需求， ESKD。SWIR波长带（也称为NIR II）与IR波长带相比对水和脂质更敏感。 可见光或NIR波段，并且可以潜在地提供更深的组织测量。FD-SWIRS将提供 宽波长范围内绝对吸收系数和约化散射系数的测量 （900-1310 nm）。FD-SWIRS将代表一种新技术，据我们所知，没有类似的 技术已被用于高清监控。FD-SWIRS将提供三种独特的无标签来源 HD监测的对比度：1）根据宽带（900-1310）计算的组织摩尔水浓度变化 nm）吸收系数（µa），2）宽带约化散射（µs′），3）结合水指数（BWI）， 利用与水分子与组织中蛋白质结合有关的细微光谱变化。我们假设 这些造影剂源将准确地显示体积状态，并提供 细胞外水与细胞内水，这已被证明是重要的容量评估。我们将 首先开发FD-SWIRS系统，并通过严格的系统测试验证性能。多层 将开发逆模型以提取深层组织光学特性。然后我们将执行前，后， 在50次透析过程中FD-SWIRS的透析中测量，假设会有变化 在HD前后时间点之间FD-SWIRS信号中。此外，我们还证明了FD-SWIRS信号将 在整个透析过程中发生变化，可能与透析相关并发症同时发生或先于透析相关并发症发生。成功 该试点项目的完成将是第一个将新技术FD-SWIRS应用于重要临床研究的项目。 这是一项旨在解决HD患者问题的研究，并将指导随后的R 01规模资金。