Carotid Intima-Media Thickness in Chronic Kidney Disease: a CRIC ancillary study

慢性肾病中的颈动脉内膜中层厚度：CRIC 辅助研究

• 批准号: 7882368
• 负责人: Sylvia E Rosas
• 金额: $ 41.41万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7882368
• 关键词: Adult; Age; American Heart Association; Ancillary Study; Atherosclerosis; Biological Assay; Biological Markers; Blood Pressure; Body mass index; C-reactive protein; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chronic; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinical; Clinical Research; Cohort Studies; Comorbidity; Data; Development; Diabetes Mellitus; Dialysis procedure; Disease Progression; Dyslipidemias; End stage renal failure; Evaluation; Event; Fibrinogen; Healthcare; Heart failure; Hypertension; Individual; Inflammation; Inflammatory; Intervention; Kidney Diseases; Lead; Left Ventricular Mass; Lipids; Measurement; Measures; Medical; Modeling; Myocardial Infarction; NIH Program Announcements; National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases; Oxidative Stress; Patients; Pennsylvania; Pharmaceutical Preparations; Population; Prevalence; Prospective Studies; Randomized Clinical Trials; Renal function; Resources; Risk; Risk Factors; Role; Severities; Site; Smoke; Smoking; Stroke; Sudden Death; Thick; Time; TimeLine; Transplantation; Ultrasonography; United States; Universities; Visit; cardiovascular disorder risk; cardiovascular risk factor; cohort; economic impact; factor C; follow-up; high risk; inflammatory marker; intima media; modifiable risk; mortality; novel; prevent; prospective; research study

DESCRIPTION (provided by applicant): Cardiovascular disease is common in chronic kidney disease (CKD) patients. CKD patients are more likely to have a cardiovascular event (myocardial infarction, stroke, heart failure and sudden death) than to progress to end-stage renal disease requiring dialysis or transplantation. Traditional risk factors, such as dyslipidemia, diabetes, smoking and hypertension, are very prevalent in this population, and contribute to the progression of CKD, but are limited predictors of cardiovascular events in these patients. Use of traditional risk factors in risk prediction scores such as the Framingham risk score results in under estimation of cardiovascular disease (CVD) risk. Recent studies have shown that novel cardiovascular risk factors such as oxidative stress and chronic inflammation are independent risk factors for cardiovascular disease in CKD patients on dialysis. We are responding to program announcement PAR-07-024, titled "Ancillary Studies to Major Ongoing NIDDK and NHLBI Clinical Research Studies". The NIDDK Chronic Renal Insufficiency Cohort (CRIC) study was initiated in 2003 to identify risk factors for CVD and progression of renal disease in adults with mild to severe CKD; follow-up visits will extend through June 2013. This cohort provides an unprecedented opportunity to investigate the role of oxidative stress and chronic inflammation in the presence and progression of CVD as measured by carotid intima-media thickness (IMT). Carotid IMT measured by ultrasound assesses the extent and severity of atherosclerosis. Preliminary data in 425 CRIC subjects demonstrate an association of IMT with traditional and non-traditional cardiovascular risk factors. The proposed prospective study will add IMT measurements in an additional 400 subjects at 2 different CRIC sites, allow for evaluation of progression of IMT in the above 425 subjects and determine if carotid IMT predicts cardiovascular events in CKD patients. Assays for oxidative stress and inflammatory markers will be measured at the same time points as the carotid IMT evaluation. he aims of the study are: to determine the prevalence and risk factors for increased carotid IMT in mild to severe CKD, to determine risk factors for progression of carotid IMT in mild to severe CKD and to determine if IMT is a predictor for cardiovascular events in CKD patients. Novel cardiovascular risk factors likely contribute to the substantial burden of cardiovascular complications in patients with CKD. Elucidation of the relationship between CVD and novel risk factors is an essential component for the prediction of cardiovascular risk and to identify modifiable risk factors for the progression of CVD that could aid in the development of anticipated randomized clinical trials to decrease disease progression.

描述（申请人提供）：心血管疾病在慢性肾脏疾病（CKD）患者中很常见。CKD患者更有可能发生心血管事件（心肌梗死、中风、心力衰竭和猝死），而不是进展为需要透析或移植的终末期肾脏疾病。传统的危险因素，如血脂异常、糖尿病、吸烟和高血压，在这一人群中非常普遍，并有助于CKD的进展，但在这些患者中心血管事件的预测因素有限。在风险预测评分中使用传统的风险因素，如Framingham风险评分，会导致对心血管疾病（CVD）风险的低估。最近的研究表明，氧化应激和慢性炎症等新的心血管危险因素是CKD透析患者心血管疾病的独立危险因素。我们正在响应项目公告PAR-07-024，标题为“主要正在进行的NIDDK和NHLBI临床研究的辅助研究”。NIDDK慢性肾功能不全队列（CRIC）研究于2003年启动，旨在确定轻度至重度CKD成人CVD和肾脏疾病进展的危险因素；随访将持续到2013年6月。该队列提供了一个前所未有的机会来研究氧化应激和慢性炎症在颈动脉内膜-中膜厚度（IMT）测量的CVD存在和进展中的作用。超声测量颈动脉IMT可评估动脉粥样硬化的程度和严重程度。425名CRIC受试者的初步数据表明，IMT与传统和非传统心血管危险因素有关。拟议的前瞻性研究将在另外400名受试者的2个不同的CRIC部位增加IMT测量，允许评估上述425名受试者的IMT进展，并确定颈动脉IMT是否预测CKD患者的心血管事件。氧化应激和炎症标志物的测定将在颈动脉IMT评估的同一时间点进行。该研究的目的是：确定轻度至重度CKD中颈动脉IMT增加的患病率和危险因素，确定轻度至重度CKD中颈动脉IMT进展的危险因素，并确定IMT是否是CKD患者心血管事件的预测因子。新的心血管危险因素可能导致CKD患者心血管并发症的严重负担。阐明心血管疾病与新型危险因素之间的关系是预测心血管风险和确定心血管疾病进展的可改变危险因素的重要组成部分，这有助于开展预期的随机临床试验，以减少疾病进展。