Maturation of Hemodialysis Arteriovenous Fistulas

血液透析动静脉瘘的成熟

• 批准号: 7686183
• 负责人: Alfred K Cheung
• 金额: $ 32.05万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-10 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686183
• 关键词: Algorithms; Ancillary Study; Arteriovenous fistula; Biological; Biological Markers; Blood; Blood Platelets; Blood Vessels; Blood flow; Characteristics; Chronic; Clinical; Clinical Trials Design; Coagulants; Cohort Studies; Development; Diagnostic tests; Dialysis patients; Dialysis procedure; Ensure; Failure; Fistula; Future; Goals; Heel; Hemodialysis; Human Resources; Individual; Interventional radiology; Kidney Diseases; Laboratory Research; Lead; Location; Measures; Mediating; Monitor; Morbidity - disease rate; Natural History; Operative Surgical Procedures; Outcome; Outcome Measure; Pathogenesis; Patients; Physical Examination; Plasma; Plethysmography; Population; Postoperative Period; Predictive Factor; Prevalence; Research; Research Personnel; Risk; Risk Factors; Specific qualifier value; Surgeon; Techniques; Thrombosis; Time; Ultrasonography; Utah; Venous; clinical care; clinical practice; demographics; design; experience; inflammatory marker; medical complication; novel; novel therapeutics; programs; prospective; skills; usability

DESCRIPTION (provided by applicant): Many arteriovenous fistulas (AVFs) suffer thrombosis or fail to mature and become usable. The Univ. of Utah will participate as a Clinical Center to conduct a prospective multi-center observational cohort study, investigating factors associated with the failure of AVF to mature. Major hypotheses are:(1) The usability of native AVF in CKD and dialysis patients can be predicted by a number of pre-, peri- and post-operative factors. (2) Defining these factors will allow the development of algorithms that are superior to physical examination alone in predicting AVF usability. (3) The blood flow rate and depth of the AVF determined by ultrasound at certain post-placement time points can serve as a surrogate for the usability of AVF. Specific Aims are to: (1) determine the pre-, peri- and post-operative local and/or systemic factors associated with AVF failure and the prevalence of these factors; (2) identify and evaluate intermediate outcomes as potential surrogates for AVF usability; (3) participate in the design and execution of the multi-center study. Other Aims are to: (4) determine the medical complications associated with the unusable AVF; (5) propose as ancillary studies the values of very early (3-hr) ultrasound results, plasma inflammation markers and novel platelet markers as predictors of AVF failure. Strengths of this application are: (1) a dedicated, multi-disciplinary team of researchers, with experience in clinical care of dialysis patients and AVF, and in clinical and laboratory research related to vascular access and kidney diseases; (2) a sizable independent academic dialysis program under the direction of the PI that would ensure maximum cooperation from the dialysis staff; (3) as Co-investigators, a surgical team that integrates vascular surgery with interventional radiology, vascular diagnostic tests and research; (4) integration of clinical and laboratory research that should facilitate the exploration of novel biological principles and therapies. Successful development of a prediction algorithm for AVF failure will help to guide the clinical practice of whether, when and how to place, monitor and/or implement corrective actions for the AVF. Identification of risk factors for usability failure and establishment of an objective biological surrogate for usability would facilitate the design of interventional trials targeting modifiable factors. Further, the pursuit of novel factors may promote the understanding of the pathogenesis of AVF failure that could potentially lead to new therapeutic strategies.

描述（由申请人提供）： 许多动静脉内瘘（AVF）会发生血栓形成或无法成熟并可用。犹他州大学将作为临床中心参与开展一项前瞻性多中心观察性队列研究，调查AVF未能成熟的相关因素。主要假设是：（1）CKD和透析患者自体AVF的可用性可通过许多术前、术中和术后因素预测。(2)定义这些因素将允许开发在预测AVF可用性方面优于单独体格检查的上级算法。(3)在某些放置后时间点通过超声确定的AVF的血流速度和深度可以作为AVF可用性的替代。具体目标是：（1）确定与AVF失败相关的术前、术中和术后局部和/或全身因素以及这些因素的患病率;（2）识别和评价中间结局作为AVF可用性的潜在替代物;（3）参与多中心研究的设计和执行。其他目标是：（4）确定与不可用AVF相关的医学并发症;（5）作为辅助研究，提出极早期（3小时）超声结果、血浆炎症标志物和新型血小板标志物作为AVF失败的预测因子的价值。该申请的优势在于：（1）一个专门的多学科研究人员团队，具有透析患者和AVF的临床护理经验，以及血管通路和肾脏疾病相关的临床和实验室研究经验;（2）在PI指导下的一个相当大的独立学术透析项目，将确保透析人员的最大合作;（3）作为合作研究者，一个将血管外科与介入放射学、血管诊断测试和研究相结合的外科团队;（4）将临床和实验室研究相结合，以促进新的生物学原理和治疗方法的探索。AVF失效预测算法的成功开发将有助于指导临床实践，即是否、何时以及如何放置、监测和/或实施AVF的纠正措施。识别可用性失败的风险因素并建立可用性的客观生物学替代物将有助于设计针对可修改因素的干预性试验。此外，追求新的因素可能会促进对AVF失败的发病机制的理解，这可能会导致新的治疗策略。