Kidney Disease, Chronic, Myocardial Dysfunction
Conditions
Keywords
coronary flow reserve, living kidney donation, peritoneal dialysis
Brief summary
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.
Detailed description
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.
Interventions
DIAGNOSTIC_TESTCoronary flow reserve assessment
Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.
DIAGNOSTIC_TESTSphygmocor
Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device
DIAGNOSTIC_TESTElectrocardiogram
An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease
OTHERBlood test
Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury
OTHERUrinary albumin/creatinine ratio
Urine will be analysed for albumin/creatinine ratio
Sponsors
University Hospital Birmingham NHS Foundation Trust
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Healthy control with normal renal function * Living kidney donor who has donated \>12 months prior to enrolment in study * Chronic kidney disease stage 5 who are pre-dialysis or on peritoneal dialysis * Able to provide written informed consent
Exclusion criteria
* Pregnancy * Known ischaemic heart disease * Diabetes mellitus * Uncontrolled hypertension * Evidence of 2nd or 3rd degree AV block or sick sinus syndrome in absence of a pacemaker * History of allergic/adverse reaction to adenosine or Sonovue * History of long QT syndrome * Severe hypotension * Significant valvular heart disease * Significant chronic obstructive pulmonary disease or asthma with bronchospasm * Unstable angina not controlled with medication * Concurrent use of dipyridamole * Decompensated heart failure * Poor echo acoustic windows * Chronic kidney disease stage 5 on haemodialysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coronary flow reserve | One baseline visit | Ultrasound-assessed coronary flow reserve. Data will be presented as a ratio (no unit) between maximal mean hyperemia flow velocity and baseline velocity |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial blood flow | One baseline visit | Ultrasound measurement of myocardial blood flow using myocardial contrast echocardiography. Data will be presented as dB/sec |
| Left ventricular ejection fraction | One baseline visit | Echocardiogram assessed left ventricular ejection fraction by Simpson's biplane method. Data will be presented as %. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pulse wave analysis | One baseline visit | Augmentation index measured using the Sphygmocor device. Data will be presented as %. |
| Pulse wave velocity | One baseline visit | Pulse wave velocity measured using the Sphygmocor device. Data will be presented as m/s |
Countries
United Kingdom
Contacts
Primary ContactAshwin Radhakrishnan, BM MRCP
Outcome results
None listed