MIND the Kidneys

描述（由申请人提供）：慢性肾脏疾病（CKD）影响12%的美国成年人口，使中风和痴呆的风险增加一倍。虽然小血管缺血性疾病与一般人群中的中风和痴呆有关，但几乎不知道大脑中小血管缺血性疾病的风险因素或小血管缺血性疾病与CKD患者临床结局的关系。我们建议通过对SPRINT MIND进行辅助研究来表征CKD、高血压和脑小血管缺血性疾病之间关系的生理机制。收缩压干预试验降低高血压的记忆和认知（SPRINT MIND）是NIH赞助的试验，旨在测试将收缩压降低至当前目标以下的策略是否会减少痴呆和脑小血管缺血性疾病的发生。在题为“MIND the Kidneys”的申请中，我们建议使用170名额外的CKD受试者来丰富SPRINT MIND的神经成像组件，并使用最先进的动脉自旋标记来增加脑灌注和灌注储备的新测量。我们的具体目标是通过评估CKD和高血压治疗是否影响脑灌注，以及脑灌注的变化是否与认知结果相关，来补充和实质性扩展SPRINT MIND的核心目标。我们已经组建了一个多学科的调查小组，以解决这些重要和创新的目标。

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects 12% of the United States adult population and it doubles the risks for stroke and dementia. While small vessel ischemic disease is linked with both stroke and dementia in the general population, almost nothing is known about the risk factors for small vessel ischemic disease in the brain or the relation of small vessel ischemic disease to clinical outcomes in patients with CKD. We propose to characterize the physiological mechanisms that underlie the relationship between CKD, hypertension, and small vessel ischemic disease in the brain by conducting an ancillary study to SPRINT MIND. The Systolic Pressure INtervention Trial Memory and cognition IN Decreased hypertension (SPRINT MIND) is an NIH sponsored trial testing whether a strategy of lowering systolic blood pressure below current targets reduces incident dementia and brain small vessel ischemic disease. In this application entitled 'MIND the Kidneys', we propose to enrich the neuroimaging component of SPRINT MIND with 170 additional subjects with CKD, and to add novel measures of brain perfusion and perfusion reserve using state-of-the-art Arterial Spin Labeling. Our specific aims complement and substantially extend the core aims of SPRINT MIND by evaluating whether CKD and hypertension therapy affect brain perfusion, and whether changes in brain perfusion correlate with cognitive outcomes. We have assembled a multi-disciplinary group of investigators to address these important and innovative aims.