ABPM AND END ORGAN DAMAGE IN CHILDREN WITH RENAL TRANSPLANTATION

肾移植儿童的动态血压监测和终末器官损伤

• 批准号: 7374523
• 负责人: MARK M. MITSNEFES
• 金额: $ 0.12万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7374523
• 关键词: ABPM; END; ORGAN; DAMAGE; CHILDREN

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Recent studies showed that nighttime hypertension as determined by ambulatory BP monitoring (ABPM) occurs almost universally in both adults and children after renal transplantation (Tx). We hypothesize that after renal Tx, increased nighttime BP in children who had normal office BP, will be associated with hypertension-related end-organ damage such as increased left ventricular mass (LVM), increased arterial stiffness and decreased kidney function. If nighttime BP is a better predictor of target organ damage than office BP, the use of ABPM would detect patients at risk and provide the rational guideline for therapy. To test this concept, we will assess in children with renal Tx cardiovascular structure and function and allograft function at baseline and after one year. Cardiac structure will be evaluated by measurement of LVM, vascular structure and function by measurement of carotid artery intima-media thickness (IMT) and allograft function by measurement of glomerular filtration rate (GFR). These measurements will be correlated with multiple variables, the most important of which will be daytime and nighttime BP as measured by ABPM. Hypertension is a strong and independent risk factor for poor long-term outcome in adults and children with renal Tx. It is hoped that improved detection of hypertension by 24-hour ABPM, especially nighttime hypertension, will lead to more effective treatment which will prevent or slow the progression of cardiac disease and allograft dysfunction. Thus, the long-term goal will be to decrease the incidence and prevalence of cardiovascular disease and delay graft failure in children and young adults with renal Tx.

该子项目是利用 NIH/NCRR 资助的中心拨款提供的资源的众多研究子项目之一。子项目和研究者 (PI) 可能已从另一个 NIH 来源获得主要资金，因此可以在其他 CRISP 条目中得到体现。列出的机构是中心的机构，不一定是研究者的机构。最近的研究表明，动态血压监测（ABPM）确定的夜间高血压几乎普遍发生在肾移植（Tx）后的成人和儿童中。我们假设，肾 Tx 后，诊室血压正常的儿童夜间血压升高，将与高血压相关的终末器官损伤相关，例如左心室质量 (LVM) 增加、动脉僵硬度增加和肾功能下降。如果夜间血压比诊室血压能更好地预测靶器官损伤，那么使用 ABPM 可以检测出处于危险中的患者，并为治疗提供合理的指导。 为了检验这一概念，我们将评估儿童的肾 Tx 心血管结构和功能以及基线和一年后的同种异体移植功能。通过测量LVM来评估心脏结构，通过测量颈动脉内膜中层厚度（IMT）来评估血管结构和功能，通过测量肾小球滤过率（GFR）来评估同种异体移植物功能。这些测量结果将与多个变量相关，其中最重要的是由 ABPM 测量的白天和夜间血压。 高血压是肾 Tx 成人和儿童长期预后不良的一个重要且独立的危险因素。希望通过 24 小时 ABPM 改进对高血压（尤其是夜间高血压）的检测，将带来更有效的治疗，从而预防或减缓心脏病和同种异体移植功能障碍的进展。因此，长期目标是降低患有肾 Tx 的儿童和年轻人心血管疾病的发病率和患病率，并延迟移植失败。