Feasibility of obtaining measured glomerular filtration rate among young adults with cerebral palsy

项目总结 患有脑性瘫痪(CP)的18-40岁年轻人的医疗保健需求未得到满足， 对肾脏疾病的易感性，这可能导致更大的过早发病和死亡风险； 然而，对慢性胰腺炎患者的肾功能知之甚少。这是由于对临床的误解。 不适合CP的肾功能测量，导致对肾脏的不准确评估 功能。在肾功能不全的早期阶段进行干预可以非常有效地降低长期风险 肾脏疾病；然而，如果没有对肾小球的准确评估，干预努力就会受到阻碍。 滤过率(GFR)，临床上衡量肾功能的金标准，在CP患者。没有研究表明 CP的测量肾小球滤过率(MGFR)。在患有CP的成人中获得mGFR的可行性尚不清楚， 非侵入性方法用传统公式估算肾小球滤过率(EGFR)的准确性。可能会有 成人CP患者mGFR检测中的特殊障碍。因此，确定临床可行性和合理性 准确评估mGFR的通畅程度是至关重要的第一步。长期目标是理解、预防、 治疗肾功能障碍，改善慢性阻塞性肺病患者的健康老龄化。这项研究的目的是 为未来的研究和临床干预奠定基础，通过确定获得 MGFR使用被广泛采用的临床试验，125I-异硫氰酸酯，和99mTC-DTPA试验，这是一种较少的- 涉及临床方案，适用于18-40岁的青壮年CP。具体地说，这项研究的主要目的 将衡量同意接洽的人的比例，完成测试的人的比例 向那些同意的人提供程序，使用有效措施进行测试的可接受性，以及退出面谈 探讨注册的障碍和促进者，以及CP参与者和 获得mgfr的经验丰富的技术人员。离职面谈将使我们能够确定和制定合理的 提供便利，以加强招聘和完成未来研究研究的测试，并通知 临床实践。如果两个临床方案都被证明是由常规临床确定的可靠的mGFR测量 标准，我们将探讨：(1)测试之间的一致性，这将为哪些测试可以提供证据 用于研究和临床；(2)mGFR和EGFR在CP严重程度上的差异程度。 该信息将启动所需的工作，以提供临床友好的CP校正因子或CP特定的 EGFR方程式以改善对这一脆弱人群的肾功能的临床监测。这项研究 是创新的，因为它将挑战目前CP肾功能正常的现状，这是应该 不适合慢性胰腺炎的常规临床措施对肾功能的误解 而不是真正的肾功能。这项研究具有重要意义，因为对肾功能的准确评估 对于CP的临床干预是必要的，以预防和延缓肾脏疾病的发生和进展。

PROJECT SUMMARY Young adults 18-40 years of age with cerebral palsy (CP) have unmet healthcare needs and heightened susceptibility for kidney disease, which may result in greater risk for premature morbidity and mortality; however, little is known about kidney function for individuals with CP. This is due to misinterpretation of clinical measures of kidney function that are not appropriate for CP, leading to inaccurate assessment of kidney function. Interventions at earlier stages of kidney dysfunction can be highly effective at mitigating long-term risk of kidney disease; however, intervention efforts are hindered without accurate assessments of glomerular filtration rate (GFR), the clinical gold-standard measure of kidney function, in patients with CP. No studies have measured GFR (mGFR) for CP. The feasibility of obtaining mGFR in adults with CP is unknown, as is the accuracy of estimating GFR (eGFR) using traditional equations through non-invasive methods. There may be specific barriers in mGFR testing for adults with CP. Therefore, identifying clinical feasibility and reasonable accommodations to accurately assess mGFR is a vital first step. The long-term goal is to understand, prevent, and treat kidney dysfunction to improve healthful aging for individuals with CP. The objective of this study is to lay the foundation for future research and clinical intervention by determining the clinical feasibility of obtaining mGFR using the widely adopted clinical test, 125I-Iothalamate, and the 99mTc-DTPA test, which is a less- involved clinical protocol, for young adults 18-40 years old with CP. Specifically, the primary Aim of this study will measure the proportion of those consented to those approached, proportion of those completing testing procedures to those consented, acceptability of testing using validated measures, and exit interviews that probe barriers and facilitators to enrollment and testing challenges for both the participants with CP and the experienced technicians obtaining mGFR. The exit interviews will allow us to identify and develop reasonable accommodations to enhance recruitment and completion of testing for future research studies and to inform clinical practice. If both clinical protocols prove reliable mGFR measures as determined by routine clinical standards, we will explore: (1) the agreement between tests, which will provide evidence of which test can be used for research and clinic; and (2) the degree of discrepancy between mGFR and eGFR by severity of CP. This information will initiate needed work in providing a clinically-friendly CP correction factor or a CP-specific equation for eGFR to improve clinical monitoring of kidney function for this vulnerable population. The research is innovative because it will challenge the current status quo that kidney function is normal for CP, which is due to misinterpretation of kidney function from routinely used clinical measures that are not appropriate for CP rather than true kidney function. The research is significant because accurate assessment of kidney function for CP is necessary for clinical interventions to prevent the onset and delay the progression of kidney disease.