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 该提案的目的是为沃尔夫格拉姆博士作为临床研究者的独立途径 以及成人透析认知和功能结果领域的专家。博士的总体目标 Wolfgram旨在改善接受治疗的末期肾脏疾病（ESRD）患者的健康和福祉 血液透析（HD）通过将职业奉献给认知和管理的评估，预防和管理 在高清人群中高度普遍的功能障碍。在此提案中，沃尔夫格拉姆博士将重点关注 高清过程中高清方面的高清危险因素的评估。当前的文献和 沃尔夫格拉姆博士的先前工作表明，除了传统的患者认知障碍风险因素外， 高清过程可能会进一步导致认知下降。常规高清会导致电路应力 导致灌注异常和巨口脑缺血性损伤。特别是由于脑损伤，可能是由于 高清期间脑灌注的变化。高清患者可能由于 来自常见合并症的血管疾病，例如糖尿病，高血压和老年，以及 ESRD特异性危险因素，例如钙和磷酸盐调节受损的血管钙化。 由于全身性血流动力学波动，可能会在HD疗程中发生脑性低渗透率 脑自动调节受损。这可能导致脑缺血性损伤和随后的认知 衰退。在此提案中 脑灌注是认知状况下降的危险因素。 Wolfgram博士将使用大脑血氧饱和度， 通过近红外光谱法测量，作为HD疗程期间脑灌注的指数。她会的 评估三个认知集中的结果1）用大脑MRI测量的脑白质完整性，2） 通过NIH工具箱认知电池中的神经心理学测试测量的认知表现，3） 患者报告了用患者报告的结果测量信息测量的认知功能 系统。这项研究的结果将确定HD期间脑血氧计的变化是否可以预测 认知结果的下降加班，并有可能确定未来治疗干预的目标 旨在减少认知能力下降。为了完成这项研究并实现她的发展目标 高清人口的临床结果研究专业知识沃尔夫拉姆博士将遵循职业发展 培训计划的重点是研究方法，脑成像，神经心理学和患者报告 结果措施。她的培训将受到她在医学院的心理和顾问的指导 威斯康星州，伯曼临床结果研究中心与马奎特大学。完成此操作 研究建议以及正式培训活动将使沃尔夫格拉姆博士能够领导针对的研究工作 减少高清人群中高度普遍的认知和功能障碍。