Kidney Disease, Chronic Clinical Trial
Official title:
Coronary Microvascular Dysfunction in Chronic Kidney Disease: The Chronic Renal Impairment in Birmingham Coronary Flow Reserve (CRIB FLOW) Study
This is an observational study assessing coronary microvascular function in healthy controls with normal kidney function, living kidney donors, pre-dialysis patients with chronic kidney disease stage 5 and patients on peritoneal dialysis.
The clinical syndrome of uraemic cardiomyopathy is prevalent in end stage renal disease and
is associated with pathological cardiovascular changes including left ventricular
hypertrophy, diastolic dysfunction and diffuse interstitial fibrosis. These combine to confer
an elevated cardiovascular risk, including an increased risk of sudden cardiac death.
The cause of this increased cardiovascular risk is not clear but it is thought that coronary
microvascular dysfunction may play a role. Coronary microvascular dysfunction is prevalent in
many myocardial disease states, such as hypertrophic cardiomyopathy and heart failure with
preserved ejection fraction, that share pathological similarities with uraemic
cardiomyopathy.
Coronary flow reserve, a marker of coronary microvascular function, can be assessed
non-invasively using echocardiography techniques. Previous studies have shown a reduction in
coronary flow reserve in patients with chronic kidney disease. However, it is not clear if
kidney donors - individuals who have a reduced kidney function but do not have progressive
kidney disease - also demonstrate microvascular dysfunction. Similarly, although there is
some evidence that patients on dialysis have improved coronary flow reserve compared to
patients with pre-dialysis chronic kidney disease stage 5, there has been limited
investigation into the role of peritoneal dialysis on coronary flow reserve.
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