MRI Technical Development and Applications in Kidney Disease

Magnetic resonance imaging (MRI), as a non-invasive and non-contrast enhanced technique, has the potential to improve patient health care and management. The overall objective of proposed project is to:

1. develop, customize, and optimize anatomic and functional MRI methods,
2. explore the use of MRI methods to study CKD and evaluate post-transplant kidneys, and
3. investigate the potential of MRI in the diagnosis, prognosis, and monitoring of the progression of renal dysfunction.

In addition to direct studies of the kidney, brain MRI studies will also be performed to identify the cerebrovascular and cognitive effects of chronic renal function deficiency and medical treatment (e.g. hemodialysis and immunosuppression). The brain and kidneys have similar vascular bed, and both are susceptible to vascular injury, which provides the pathological basis for the widely recognized association of reduced renal function with prevalent cerebrovascular diseases (CVDs) and cognitive impairment (CI). The MRI methods in the brain will be applied to explore the origins for widely observed CVDs and prevalent cognitive impairment (CI) in kidney disease patients.

Study Overview

• Status: Recruiting
• Conditions: Chronic Kidney Diseases; Cognition Disorders; Kidney Transplantation; Dialysis

Detailed Description

Specific Aims

The overall objective is to develop and validate MRI methods for the evaluation and monitoring of renal status and associated cerebrovascular effects of renal dysfunction and treatment. The proposed project include two phases: 1) MRI technical development and validation with reproducibility studies; 2) clinical pilot studies with two patient populations (CKD patients and renal transplant recipients) to explore the potential of MRI in evaluating CKD, post-transplantation renal dysfunction and cerebrovascular pathophysiology associated with or induced by reduced kidney function and renal replacement treatment. The ultimate goal is to use MRI as a non-invasive and non-contrast enhanced tool to facilitate the diagnosis and prognosis of renal dysfunction and associated diseases, and to assess the efficacy of therapeutic interventions, and monitor disease progress across time.

Specific Aim 1: Imaging technical development and protocol optimization for renal and cerebral MRI.

The overall goal is to develop, customize and optimize new MRI methods to overcome challenges due to physiological motions and facilitate clinical research studies of renal and cerebral diseases, which will include but not are limited to the following aspects.

Sub-Aim 1.1: Develop imaging methods to improve MRI quality and efficiency for renal disease studies.

Sub-Aim 1.2: Optimize gas-challenge functional MRI protocols to study cerebral and renal vascular endothelial dysfunction.

Sub-Aim 1.3: Evaluate the reproducibility of cerebral and renal MRI methods.

Specific Aim 2: Perform pilot studies to evaluate the potential of MRI in CKD patients and renal transplant recipients.

Sub-Aim 2.1: Evaluate the correspondence of MRI measures with clinical metrics (i.e. eGFR) and routinely assessed cognitive functions from CKD and ESRD patients.

This will be accomplished by performing both cross-sectional and longitudinal studies, which will allow us to evaluate the diagnostic and prognostic potential of these non-invasive imaging methods. The investigators hypothesize that the measurements from cerebral and/or renal MRI can effectively reflect cerebral and/or renal (anatomic and physiological) changes induced by CKD or dialysis treatment.

Sub-Aim 2.2: Investigate the potential of MRI methods in the evaluation of post-transplant kidneys.

This will be accomplished by imaging transplant recipients in three distinct cohorts; those with good allograft function but coming in for routine protocol biopsy, with stable renal function, and with unstable renal function due to post-transplant complications. These patient populations will receive protocol biopsies (i.e. scheduled repeat biopsies) as standard of care; therefore pathologic results will be available for correlation with MRI measures. The investigators hypothesize that MRI methods can be a non-invasive surrogate marker of renal tissue properties and functional changes induced by renal post-transplant dysfunction (e.g. renal rejection) currently only obtained through biopsy.

• Study Type: Observational
• Enrollment (Anticipated): 180

Contacts and Locations

• Study Contact: Name: Xiufeng Li, Ph.D.; Phone Number: 612-625-7872; Email: lixx1607@umn.edu
• Study Contact Backup: Name: Michelle Hartwig; Phone Number: 612-626-0021; Email: mhartwig@umn.edu

Study Locations

• United States
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Recruiting
      • Center for Magnetic Resonance Research
      • Contact: Xiufeng Li, Ph.D.; Phone Number: 612-626-2001
      • Principal Investigator: Xiufeng Li, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study populations vary across specific aims: normal healthy or control volunteers for Specific Aim 1, CKD patients and renal transplant recipients for Specific Aim 2.

Description

For Specific Aim 1: MRI Technical Development Studies

Inclusion Criteria:

1. Healthy Volunteer

Exclusion Criteria:

1. Ferromagnetic implants
2. Any foreign metal objects in the body
3. History of shrapnel or shot gun injury
4. Cardiac pacemakers
5. Defibrillator
6. Neuronal stimulator
7. Magnetic aneurysm clip
8. Large tattoos on the abdomen or the brain and neck
9. Hip replacement
10. Too large to fit in the magnet (body mass index >= 40, approx.)
11. Severe claustrophobia
12. Women with pregnancy

For Specific Aim 2: Pilot Studies with Patients

Studies for CKD

Inclusion

1. English- speaking as primary language.
2. Age 45 years and older
3. Able to complete an approximately 90 minute cognitive testing battery.
4. Able to sign the informed consent, or allow a caregiver, relative, surrogate, or witness to sign the informed consent if participant is unable to do so.
5. GFR < 90 ml/min/1.73m2

Exclusion

1. Acute psychiatric illness that would impede cognitive testing
2. Active chemical dependence, such as alcohol, narcotics or other drugs
3. Legally blind or unable to complete cognitive tests due to visual loss or deafness
4. Dialysis dependent or renal transplant recipient at time of screening or baseline
5. Chronic obstructive pulmonary disease
6. Severe CI unable to complete the Modified Mini-Mental State Examination [3MSE]

Studies for Renal Transplantation

Inclusion

1. Able to sign the informed consent, or allow a caregiver, relative, surrogate, or witness to sign the informed consent if participant is unable to do so.
2. Age 45 years and older

Exclusion

1. Not on dialysis due to allograft failure
2. Chronic obstructive pulmonary disease

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort
Normal Healthy Volunteer
Non-CKD Control
Chronic Kidney Disease (CKD)
Dialysis Patients
Renal Transplant Recipients

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correspondence of MRI measures with clinical metrics (i.e. eGFR) and routinely assessed cognitive functions from CKD and ESRD patients.	MRI measures will be evaluated both globally and regionally (e.g. frontal lobe and the hippocampus of the brain, renal cortex and medulla in each and both kidneys). The correlations among MRI measurements, the degree of CKD disease (as evaluated by eGFR) and the severity of cognitive impairment will be assessed using both cross-sectional and longitudinal analyses. Non-parametric analysis approach will be used instead of parametric if appropriate.	up to three years
The potential of MRI methods in the evaluation of post-transplant kidneys.	For each region in kidneys (renal cortex and medulla), each MRI measurement from the cross-sectional studies of transplant recipients with stable renal functional will be correlated to the levels of transplant kidney function (e.g. eGFR). Imaging results from transplant recipients with unstable renal function will be compared between patients with and without diagnosed acute rejection, and before and after the acute rejection treatment for patients with positive response. Note: For both outcomes, multi-parametric MRI measurements will be used in the evaluation, including but not limited to MRI relaxation times, blood flow and diffusion.	Up to three years

Collaborators and Investigators

• Sponsor: University of Minnesota
• Investigators: Principal Investigator: Xiufeng Li, Ph.D., Univesity of Minnesota

Study record dates

Study Major Dates

• Study Start (Actual): March 30, 2023
• Primary Completion (Anticipated): December 30, 2026
• Study Completion (Anticipated): December 30, 2026

Study Registration Dates

• First Submitted: April 15, 2015
• First Submitted That Met QC Criteria: April 17, 2015
• First Posted (Estimate): April 20, 2015

Study Record Updates

• Last Update Posted (Actual): May 12, 2023
• Last Update Submitted That Met QC Criteria: May 11, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Urologic Diseases; Neurocognitive Disorders; Renal Insufficiency; Kidney Diseases; Renal Insufficiency, Chronic; Cognition Disorders
• Other Study ID Numbers: 1410M54981

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED