Cardiovascular Diseases Clinical Trial
Official title:
Oxidative Stress in Chronic Kidney Disease
The purpose of this study is to determine how the progressive loss of kidney function influences cardiovascular disease.
BACKGROUND:
Currently, both the incidence and prevalence of chronic kidney disease leading to end-stage
renal disease (ESRD) continue to increase at an alarming rate in the United States.
According to the United States Renal Data System, in 2000 there were 370,000 prevalent ESRD
patients, which was expected to grow to 610,000 by the year 2010. Furthermore, the adjusted
death rate for all incident ESRD patients was 19.8 per 100 patient years at risk, with
cardiovascular disease accounting for more than 50 percent of mortality in this patient
population. Recent analyses demonstrate that there are at least 10.9 million people in the
United States with chronic kidney disease and, that for this population, there are
substantially increased cardiovascular risks, prompting the Surgeon General to include
chronic kidney disease as a focus area for improving the nation's health in Healthy People
2010. The metabolic derangements accompanying progressive loss of kidney function lead to
unique patterns of oxidative injury specific to the uremic state. For patients with chronic
kidney disease, non-traditional risk factors for cardiovascular disease such as increased
oxidative stress and inflammation may be especially important.
DESIGN NARRATIVE:
The broad goals of this study are to develop enhanced understanding of how the progressive
loss of kidney function leads to increased oxidative stress, inflammation, and accelerated
development of cardiovascular disease. The long-term objective of this proposal is to
develop the data critical for a subsequent large scale, multicenter, randomized, controlled
trial designed to alleviate oxidative stress, reduce inflammation, and reduce cardiovascular
morbidity in patients with chronic kidney disease. The aims of this study are to determine
in a prospective study the extent to which oxidative stress is a risk factor for
cardiovascular events in patients with chronic kidney disease and to characterize the
inter-relationships between oxidative stress and inflammation. A further aim is to determine
in the longitudinal study is how progressive loss of kidney function influences oxidative
stress propensity to inflammation and cardiovascular disease. An additional aim is to
determine the effects of antioxidant therapy on biomarkers of oxidative stress, markers of
inflammation and endothelium-dependent vascular function in patients with chronic kidney
disease. This study incorporates a series of observational and interventional studies
measuring the extent of cardiovascular disease with extensive ex vivo measures of biomarkers
of oxidative stress and inflammation in patients with chronic kidney disease. Coordination
between the clinical data and the ex vivo studies will be emphasized to achieve maximal
understanding of the pathophysiology of uremic cardiovascular disease.
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