Bone Quality and Mechanical Competence In Chronic Kidney Disease

慢性肾脏病的骨质量和机械能力

• 批准号: 7994914
• 负责人: THOMAS L. NICKOLAS
• 金额: $ 5.38万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7994914
• 关键词: 3-Dimensional; Academic Medical Centers; Adult; Age; Area; Arts; Award; Biological Markers; Biomechanics; Biometry; Biopsy; Biopsy Specimen; Body mass index; Bone Density; Bone Diseases; Bone remodeling; Cellular biology; Characteristics; Chronic Kidney Failure; Clinical Investigator; Competence; Cross-Sectional Studies; Data Set; Deterioration; Development Plans; Diagnostic tests; Dialysis patients; Dialysis procedure; Discrimination; Dual-Energy X-Ray Absorptiometry; End stage renal failure; Endocrinology; Epidemiologic Methods; Evolution; Finite Element Analysis; Fracture; Functional disorder; Gender; General Population; Goals; Gold; Hand; Hip Fractures; Hip region structure; Hormones; Image; Incidence; Individual; Kidney; Knowledge; Measurement; Measures; Mechanics; Medical; Mentors; Metabolic Bone Diseases; Minerals; Morbidity - disease rate; Nephrology; Osteoporosis; Patients; Peripheral; Predisposition; Prevalence; Public Health; Race; Radial; Receiver Operating Characteristics; Renal Osteodystrophy; Renal function; Reporting; Research Personnel; Resolution; Risk; Scanning; Sensitivity and Specificity; Serum Markers; Severities; Severity of illness; Site; Staging; Structure; Techniques; Technology; Testing; Thick; Training; Vertebral column; X-Ray Computed Tomography; bone; bone cell; bone mass; bone quality; bone strength; bone turnover; career development; high risk; imaging modality; improved; indexing; meetings; mortality; new technology; novel marker; public health relevance; skills; substantia spongiosa; tibia; tool; ultra high resolution

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) prevalence is increasing rapidly and fracture incidence is much higher in patients with CKD than in the general population. Unfortunately, fracture risk prediction by dual energy X-ray absorptiometry (DXA) is poorer among CKD patients than in the general population and improved imaging methods are necessary to evaluate their fracture susceptibility. Ultra high resolution peripheral quantitative computed tomography (HRpQCT; resolution 80-100 um) is a novel technology that characterizes both cortical and trabecular microarchitecture. Finite element analysis (FEA), a measure of bone strength, can be applied to HRpQCT data sets. The hypotheses of this application are that CKD stages 3 to 5 are associated with progressive alterations in trabecular and cortical microarchitecture that reduce strength and increase fracture susceptibility, and HRpQCT with FEA, will provide greater fracture discrimination than DXA in patients with CKD. We will test this hypothesis in a cross-sectional study of 150 subjects with CKD stages 3 to 5 (75 with fracture). In a subset, we will validate HRpQCT measurements, established and novel markers of bone turnover against histomorphometry of transiliac bone biopsies. In CKD stage 4 subjects (n=50) we will longitudinally evaluate bone microarchitecure in relation to changes in kidney function. This study is highly relevant to public health, as fracture risk and its associated morbidity and mortality are exceedingly high in CKD patients and CKD and osteoporosis are highly coprevalent. This project also forms the training platform of my 5-year career development plan, the goal of which is to allow me to become an independent clinical investigator in the field of CKD-mineral and bone disorders (MBD). The plan includes didactic training in radiographic imaging, advanced biostatistics and epidemiological methods, specific hands-on training in HRpQCT, FEA and quantitative histomorphometry of transiliac bone biopsies with leading experts in the fields of bone biomechanics and bone cell biology, and frequent meetings with my mentor and co-mentor, leaders in the field of metabolic bone disease and CKD-MBD. During the award, I will develop expertise in using these tools to assess bone strength in CKD patients. In the fourth year, I will begin planning an RO1 submission. The skills and knowledge I acquire during this award will allow me to develop into a productive, independent investigator with a skill set that is unusual in the fields of nephrology and endocrinology. PUBLIC HEALTH RELEVANCE: This study is highly relevant to public health, as fracture risk and its associated morbidity and mortality are exceedingly high in CKD patients and CKD and osteoporosis are highly coprevalent.

描述（由申请人提供）：