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

• 批准号: 10112899
• 负责人: Dawn F. Wolfgram
• 金额: $ 17.74万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 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/10112899
• 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; 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

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.

项目摘要/摘要 这项建议的目的是为沃尔夫格拉姆博士提供一条独立成为临床研究员的途径。 在成人透析的认知和功能结果领域的专家。博士的总体目标是。 Wolfgram是用来改善终末期肾病(ESRD)患者的健康和福祉的 血液透析(HD)致力于评估、预防和管理认知和 在HD人群中非常普遍的功能障碍。在这项提案中，沃尔夫格拉姆博士将把重点放在 评估HD队列中HD过程特有的认知功能减退的危险因素。当前的文学和 沃尔夫格拉姆博士之前的工作表明，除了传统的患者认知障碍风险因素外， HD过程可能进一步导致认知功能下降。传统的HD会导致循环应激， 导致终末器官血流灌注异常和缺血性损伤。脑损伤，具体地说，可能是由于 HD期间脑血流灌注的变化。服用HD的患者可能由于以下原因而导致大脑自动调节功能受损 由糖尿病、高血压和老年等常见并存疾病引起的血管疾病 ESRD特有的风险因素，如钙和磷调节受损导致的血管钙化。 在HD期间，由于环境中的全身血流动力学波动，可能会发生脑低灌注 大脑自动调节功能受损。这可能会导致脑缺血损伤和随后的认知 拒绝。在这项建议中，沃尔夫格拉姆博士将进行一项前瞻性队列研究，评估传统透析中的变化 脑血流灌注是认知状态下降的危险因素。沃尔夫格拉姆博士将使用脑氧仪， 通过近红外光谱测量，作为HD过程中脑血流灌注的指标。她会的 评估三种集中认知的结果1)脑部MRI测量的脑白质完整性，2) 用NIH工具箱认知电池中的神经心理测试来测量认知表现，以及3) 使用患者报告结果测量信息测量患者报告的认知功能 系统。这项研究的结果将确定HD期间脑氧饱和度的变化是否可以预测 随着时间的推移，认知结果的下降，并可能确定未来治疗干预的目标 旨在减少认知衰退。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方面的专业知识沃尔夫格拉姆博士将跟踪职业发展 培训计划侧重于研究方法、脑成像、神经心理学和患者报告 结果衡量标准。她的训练将由她在纽约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。完成这项工作 研究提案以及正式的培训活动将使沃尔夫格拉姆博士能够领导旨在 减少在我们的HD人群中非常普遍的认知和功能障碍。