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: 8300240
• 负责人: Sylvia E Rosas
• 金额: $ 17.85万
• 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 2013-07-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8300240
• 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; Clinical Trials; Cohort Studies; Comorbidity; Data; Development; Diabetes Mellitus; Dialysis procedure; Disease Progression; Dyslipidemias; End stage renal failure; Evaluation; Event; Fibrinogen; Future; 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; Risk; Risk Factors; Role; Severities; Site; Smoking; Stroke; Sudden Death; Thick; Time; TimeLine; Transplantation; Ultrasonography; United States; Universities; Visit; age group; 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

ABSTRACT 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 underestimation 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. The 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. PROJECT NARRATIVE Cardiovascular disease is 5-10 times more likely in patients with chronic kidney disease compared to people of their same age group. It is important to identify individuals at high risk for events using non- invasive measures. We propose to utilize a measure of the carotid vessels by ultrasound to determine if we can identify patients at risk for cardiovascular disease. This will aid in future clinical trials to slow disease progression.

摘要 心血管疾病在慢性肾脏疾病(CKD)患者中很常见。慢性肾脏病患者更有可能 发生心血管事件(心肌梗塞、中风、心力衰竭和猝死)比 进展到需要透析或移植的终末期肾脏疾病。传统风险因素，如 血脂异常、糖尿病、吸烟和高血压在这一人群中非常普遍，并导致 CKD的进展，但对这些患者的心血管事件的预测有限。使用 风险预测分数中的传统风险因素，如Framingham风险分数，会导致低估 心血管疾病(CVD)风险。最近的研究表明，新的心血管危险因素 如氧化应激和慢性炎症是心血管疾病的独立危险因素 慢性肾脏病患者接受透析治疗。 我们是对项目公告PAR-07-024的回应，该项目的标题是《正在进行的重大辅助研究》 NIDDK和NHLBI临床研究。NIDDK慢性肾功能不全队列(CRIC)研究 于2003年启动，目的是确定轻度至重度肾病成人心血管疾病和肾脏疾病进展的危险因素。 严重的慢性肾脏病；后续访问将持续到2013年6月。这一群体提供了前所未有的 有机会研究氧化应激和慢性炎症在存在和 用颈动脉内膜中层厚度(IMT)来衡量心血管疾病的进展。颈动脉内膜厚度的测量 超声波可以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 证明IMT与传统和非传统心血管危险因素之间的关联。这个 拟议的前瞻性研究将在2个不同的CRIC增加另外400名受试者的IMT测量 可以评估上述425名受试者的IMT进展情况，并确定颈动脉IMT 预测CKD患者的心血管事件。氧化应激和炎症标志物的检测将 与颈动脉IMT评价在同一时间点进行测量。 本研究的目的是：确定轻度到中度颈动脉IMT增高者的患病率和危险因素。 目的：探讨轻、重度CKD患者颈动脉IMT进展的危险因素。 如果IMT是CKD患者心血管事件的预测因子。可能存在新的心血管危险因素 对慢性肾脏病患者的心血管并发症造成很大负担。澄清： 心血管疾病与新危险因素的关系是预测心血管疾病的重要组成部分。 心血管风险，并找出心血管疾病进展的可改变的危险因素 开发预期的随机临床试验以减少疾病进展。项目叙事 与慢性肾病患者相比，慢性肾脏疾病患者患心血管疾病的可能性高5-10倍 同年龄段的人。识别事件的高危人群非常重要，使用非 侵入性措施。我们建议利用超声测量颈动脉血管来确定我们是否 可以识别有心血管疾病风险的患者。这将有助于未来延缓疾病的临床试验。 进步。