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Effect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: Rationale and design of the EARNEST study

There is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population wit... Full description

Journal Title: American Heart Journal 2014, Vol.167 (2), p.141-149.e2
Main Author: Moody, William E
Other Authors: Tomlinson, Laurie A , Ferro, Charles J , Steeds, Richard P , Mark, Patrick B , Zehnder, Daniel , Tomson, Charles R , Cockcroft, John R , Wilkinson, Ian B , Townend, Jonathan N
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-8703
Link: https://www.ncbi.nlm.nih.gov/pubmed/24439974
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3904213
title: Effect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: Rationale and design of the EARNEST study
format: Article
creator:
  • Moody, William E
  • Tomlinson, Laurie A
  • Ferro, Charles J
  • Steeds, Richard P
  • Mark, Patrick B
  • Zehnder, Daniel
  • Tomson, Charles R
  • Cockcroft, John R
  • Wilkinson, Ian B
  • Townend, Jonathan N
subjects:
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood pressure
  • Blood Pressure - physiology
  • Bone density
  • Cardiology
  • Cardiovascular Medicine
  • Chronic kidney failure
  • Donation of organs, tissues, etc
  • Drug therapy
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate - physiology
  • Humans
  • Kidney Failure, Chronic - physiopathology
  • Kidney Failure, Chronic - surgery
  • Kidney Transplantation - methods
  • Living Donors
  • Male
  • Middle Aged
  • Mortality
  • Nephrectomy - methods
  • Prospective Studies
  • Tissue and Organ Harvesting - methods
  • Trial Design
  • Vascular Stiffness - physiology
  • Young Adult
ispartof: American Heart Journal, 2014, Vol.167 (2), p.141-149.e2
description: There is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group. The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure. This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease. These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm a
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleEffect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: Rationale and design of the EARNEST study
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creatorMoody, William E ; Tomlinson, Laurie A ; Ferro, Charles J ; Steeds, Richard P ; Mark, Patrick B ; Zehnder, Daniel ; Tomson, Charles R ; Cockcroft, John R ; Wilkinson, Ian B ; Townend, Jonathan N
creatorcontribMoody, William E ; Tomlinson, Laurie A ; Ferro, Charles J ; Steeds, Richard P ; Mark, Patrick B ; Zehnder, Daniel ; Tomson, Charles R ; Cockcroft, John R ; Wilkinson, Ian B ; Townend, Jonathan N
descriptionThere is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group. The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure. This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease. These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program (NCT01769924).
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subjectAdolescent ; Adult ; Aged ; Aged, 80 and over ; Blood pressure ; Blood Pressure - physiology ; Bone density ; Cardiology ; Cardiovascular Medicine ; Chronic kidney failure ; Donation of organs, tissues, etc ; Drug therapy ; Female ; Follow-Up Studies ; Glomerular Filtration Rate - physiology ; Humans ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - surgery ; Kidney Transplantation - methods ; Living Donors ; Male ; Middle Aged ; Mortality ; Nephrectomy - methods ; Prospective Studies ; Tissue and Organ Harvesting - methods ; Trial Design ; Vascular Stiffness - physiology ; Young Adult
ispartofAmerican Heart Journal, 2014, Vol.167 (2), p.141-149.e2
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descriptionThere is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group. The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure. This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease. These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program (NCT01769924).
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13Follow-Up Studies
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16Kidney Failure, Chronic - physiopathology
17Kidney Failure, Chronic - surgery
18Kidney Transplantation - methods
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20Male
21Middle Aged
22Mortality
23Nephrectomy - methods
24Prospective Studies
25Tissue and Organ Harvesting - methods
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27Vascular Stiffness - physiology
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titleEffect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: Rationale and design of the EARNEST study
authorMoody, William E ; Tomlinson, Laurie A ; Ferro, Charles J ; Steeds, Richard P ; Mark, Patrick B ; Zehnder, Daniel ; Tomson, Charles R ; Cockcroft, John R ; Wilkinson, Ian B ; Townend, Jonathan N
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1Adult
2Aged
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6Bone density
7Cardiology
8Cardiovascular Medicine
9Chronic kidney failure
10Donation of organs, tissues, etc
11Drug therapy
12Female
13Follow-Up Studies
14Glomerular Filtration Rate - physiology
15Humans
16Kidney Failure, Chronic - physiopathology
17Kidney Failure, Chronic - surgery
18Kidney Transplantation - methods
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1Tomlinson, Laurie A
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4Mark, Patrick B
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8Wilkinson, Ian B
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atitleEffect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: Rationale and design of the EARNEST study
jtitleAmerican Heart Journal
addtitleAm Heart J
date2014-02
risdate2014
volume167
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issn0002-8703
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notesOn behalf of the EARNEST study investigators.
abstractThere is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group. The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure. This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease. These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program (NCT01769924).
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