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Intra-dialytic cerebral oximetry and cognitive decline in adults on hemodialysis

成人血液透析患者透析中脑血氧饱和度和认知能力下降

基本信息

批准号：
10353382
负责人：
Dawn F. Wolfgram
金额：
$ 17.31万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-15 至 2023-03-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10353382
关键词：
Adult Affect Age American Anisotropy Brain Brain Injuries Brain imaging Cerebrovascular Disorders Cerebrum Clinical Clinical Investigator Cognition Cognitive Data Dementia Development Plans Diabetes Mellitus Dialysis procedure Diffusion Disease End stage renal failure Evaluation Future Goals Health Hemodialysis Homeostasis Hypertension Image Impaired cognition Impairment Information Systems Intervention Knowledge Lead Link Literature Magnetic Resonance Imaging Measurement Measures Mentors Methods Monitor Near-Infrared Spectroscopy Neuropsychological Tests Neuropsychology Organ Outcome Outcome Measure Outcomes Research Oxygen saturation measurement Pathway interactions Patient Outcomes Assessments Patient risk Patients Perfusion Peritoneal Dialysis Personal Satisfaction Physical Function Physiological Population Prevention Process Prospective Studies Prospective cohort study Recurrence Regulation Reporting Research Research Methodology Research Proposals Risk Risk Factors Role Stress Structure Surveys Testing Therapeutic Intervention Time Training Training Activity United States National Institutes of Health Universities Vascular Diseases Vascular calcification White Matter Hyperintensity Wisconsin Work brain magnetic resonance imaging calcium phosphate career career development cerebral atrophy cerebral hypoperfusion cerebral ischemic injury clinical care clinical center clinically significant cognitive function cognitive performance cognitive testing cohort comorbidity diabetic executive function functional disability functional outcomes hemodynamics high risk hypoperfusion improved indexing innovation ischemic injury medical schools mortality novel strategies performance tests preservation prevent primary outcome white matter

项目摘要

Project Summary/Abstract The objective of this proposal is to provide Dr. Wolfgram a pathway to independence as a clinical investigator and expert in the field of cognitive and functional outcomes in adults on dialysis. The overall goal of Dr. Wolfgram is to improve the health and well-being of patients with end stage renal disease (ESRD) treated with hemodialysis (HD) by dedicating her career to evaluation, prevention and management of the cognitive and functional impairment that is highly prevalent in the HD population. In this proposal Dr. Wolfgram will focus on evaluation of a HD process-specific risk factor for cognitive decline in a HD cohort. The current literature and Dr. Wolfgram’s prior work suggest that, in addition to traditional patient risk factors for cognitive impairment, the HD process may further contribute to cognitive decline. Conventional HD causes circulatory stress that can lead to perfusion abnormalities and ischemic injury in end-organs. Brain injury, specifically, may occur due to changes in cerebral perfusion during HD. Patients on HD may have impaired cerebral auto-regulation due to vascular disease from common comorbid conditions such as diabetes, hypertension, and older age and from ESRD-specific risk factors such as vascular calcification from impaired calcium and phosphate regulation. Cerebral hypo-perfusion may occur during HD sessions due to systemic hemodynamic fluctuation in the setting of impaired cerebral autoregulation. This may lead to cerebral ischemic injury and subsequent cognitive decline. In this proposal Dr. Wolfgram will conduct a prospective cohort study evaluating intradialytic change in cerebral perfusion as a risk factor for decline in cognitive status. Dr. Wolfgram will use cerebral oximetry, measured by near-infrared spectroscopy, as an index for cerebral perfusion during HD sessions. She will evaluate three cognitive focused outcomes 1) cerebral white matter integrity measured with brain MRI, 2) cognitive performance measured with neuropsychological tests in the NIH Toolbox cognition battery, and 3) patient reported cognitive function measured with the Patient Reported Outcomes Measurement Information Systems. Results of this study will determine if changes in cerebral oximetry during HD are predictive of decline in cognitive outcomes overtime, and potentially identify a target for future therapeutic intervention aimed at reducing cognitive decline. In order to complete this study and achieve her goal of developing expertise in clinical outcomes research in the HD population Dr. Wolfgram will follow a career development training plan focused on research methodology, cerebral imaging, neuropsychology, and patient reported outcome measures. Her training will be guided by her mentor and advisors at the Medical College of Wisconsin, the Berman Center for Clinical Outcomes Research and Marquette University. Completion of this research proposal along with the formal training activities will allow Dr. Wolfgram to lead research work aimed at reducing the cognitive and functional impairment that is highly prevalent in our HD population.

项目总结/摘要该提案的目的是为Wolfgram博士提供一条独立作为临床研究者的途径是成人透析患者认知和功能结局领域的专家。博士的总体目标。 Wolfgram旨在改善终末期肾病（ESRD）患者的健康和福祉，血液透析（HD）通过致力于她的职业生涯的评估，预防和管理的认知和在HD人群中非常普遍的功能障碍。在这份提案中，沃尔夫格拉姆博士将重点关注评价HD队列中认知功能下降的HD过程特异性风险因素。目前的文献和博士Wolfgram先前的研究表明，除了传统的认知障碍患者风险因素外， HD过程可能进一步导致认知能力下降。传统HD会导致循环压力，导致终末器官灌注异常和缺血性损伤。脑损伤，特别是，可能会发生由于 HD期间脑灌注的变化。HD患者的大脑自动调节功能可能受损，血管疾病的常见共病条件，如糖尿病，高血压，老年人和来自 ESRD特异性风险因素，如钙磷调节受损导致的血管钙化。血液透析过程中，由于系统血流动力学波动，可能会发生脑灌注不足大脑自动调节功能受损这可能导致脑缺血性损伤和随后的认知功能障碍。下降在本提案中，Wolfgram博士将进行一项前瞻性队列研究，评价透析中脑灌注作为认知状态下降的危险因素。沃尔夫格拉姆医生会用脑血氧仪通过近红外光谱测量，作为HD期间脑灌注的指标。她将评价三个认知焦点结局：1）通过脑部MRI测量的大脑白色物质完整性，2）用NIH认知成套测验中的神经心理学测试测量的认知表现，以及3）使用患者报告结局测量信息测量的患者报告认知功能系统.本研究的结果将确定HD期间脑血氧测定的变化是否可预测随着时间的推移，认知结果下降，并可能确定未来治疗干预的目标旨在减少认知能力下降。为了完成这项研究，实现她的发展目标，在HD人群的临床结果研究专业知识博士Wolfgram将遵循职业发展培训计划侧重于研究方法、脑成像、神经心理学和患者报告结果测量。她的培训将由她在医学院的导师和顾问指导威斯康星州，伯曼临床结果研究中心和马奎特大学。完成本研究计划沿着正式的培训活动，将使沃尔夫格拉姆博士能够领导研究工作，在减少认知和功能障碍，这是非常普遍的，在我们的HD人口。