Maturation of Hemodialysis Arteriovenous Fistulas

血液透析动静脉瘘的成熟

• 批准号: 7899601
• 负责人: Alfred K Cheung
• 金额: $ 33.96万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7899601
• 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

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.

许多动静脉内瘘（AVF）会发生血栓形成或无法成熟并可用。大学 犹他州将作为一个临床中心参与开展一项前瞻性多中心观察性队列研究， 调查与AVF成熟失败相关的因素。主要假设是：（1）可用性 CKD和透析患者中的自体AVF可通过术前、术中和术后的一些指标预测， 因素(2)定义这些因素将允许开发优于物理的上级算法 单独检查预测AVF可用性。(3)AVF的血流速度和深度由以下测定： 在某些放置后时间点的超声可以作为AVF可用性的替代。具体 目的是：（1）确定术前、术中和术后与下列因素相关的局部和/或全身因素： AVF失败和这些因素的患病率;（2）识别和评价潜在的中间结局 AVF可用性的替代品;（3）参与多中心研究的设计和执行。其他 目的是：（4）确定与不可用AVF相关的医学并发症;（5）建议 辅助研究非常早期（3小时）超声结果，血浆炎症标志物和新的 血小板标志物作为AVF失败的预测因子。该应用程序的优点是：（1）一个专门的， 多学科研究团队，具有透析患者和AVF的临床护理经验， 与血管通路和肾脏疾病相关的临床和实验室研究;（2）相当大的独立研究 在PI的指导下开展学术透析计划，以确保来自 透析工作人员;（3）作为合作研究者，一个将血管外科与介入治疗相结合的外科团队 放射学，血管诊断测试和研究;（4）临床和实验室研究的整合， 应该有助于探索新的生物学原理和疗法。成功开发A AVF失败的预测算法将有助于指导临床实践是否，何时以及如何放置， 监控和/或实施AVF的纠正措施。识别可用性失效的风险因素， 建立可用性的客观生物学替代物将有助于介入治疗的设计， 针对可变因素的试验。此外，对新颖因素的追求可能会促进对 AVF失败的发病机制，可能导致新的治疗策略。