MIND the Kidneys

描述(由申请人提供)：慢性肾脏疾病(CKD)影响了美国12%的成年人，它使中风和痴呆症的风险增加了一倍。虽然在普通人群中，小血管缺血性疾病与中风和痴呆有关，但对CKD患者脑内小血管缺血性疾病的危险因素或小血管缺血性疾病与临床预后的关系几乎一无所知。我们建议通过对Sprint Mind进行一项辅助研究来表征CKD、高血压和脑内小血管缺血性疾病之间关系的生理机制。收缩压干预试验记忆和认知降低高血压(Sprint Mind)是由NIH赞助的一项试验，测试将收缩压降低到当前目标以下的策略是否可以减少痴呆症和脑小血管缺血性疾病的发生。在这项题为“注意肾脏”的应用中，我们建议用170名患有CKD的额外受试者来丰富Sprint Mind的神经成像部分，并使用最先进的动脉自旋标记来增加脑灌注和灌注储备的新测量。我们的具体目标是通过评估慢性肾脏病和高血压治疗是否影响脑灌注，以及脑灌注的变化是否与认知结果相关，来补充和大幅扩展Sprint Mind的核心目标。我们已经组建了一个多学科的调查小组，以解决这些重要的创新目标。

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects 12% of the United States adult population and it doubles the risks for stroke and dementia. While small vessel ischemic disease is linked with both stroke and dementia in the general population, almost nothing is known about the risk factors for small vessel ischemic disease in the brain or the relation of small vessel ischemic disease to clinical outcomes in patients with CKD. We propose to characterize the physiological mechanisms that underlie the relationship between CKD, hypertension, and small vessel ischemic disease in the brain by conducting an ancillary study to SPRINT MIND. The Systolic Pressure INtervention Trial Memory and cognition IN Decreased hypertension (SPRINT MIND) is an NIH sponsored trial testing whether a strategy of lowering systolic blood pressure below current targets reduces incident dementia and brain small vessel ischemic disease. In this application entitled 'MIND the Kidneys', we propose to enrich the neuroimaging component of SPRINT MIND with 170 additional subjects with CKD, and to add novel measures of brain perfusion and perfusion reserve using state-of-the-art Arterial Spin Labeling. Our specific aims complement and substantially extend the core aims of SPRINT MIND by evaluating whether CKD and hypertension therapy affect brain perfusion, and whether changes in brain perfusion correlate with cognitive outcomes. We have assembled a multi-disciplinary group of investigators to address these important and innovative aims.