Skeletal Muscle Oxygenation in Patients With Chronic Kidney Disease Stage 2, 3 and 4
調査の概要
状態
条件
詳細な説明
This is a cross-sectional study performed in the Department of Nephrology, Hippokration Hospital, Thessaloniki, Greece. For the purposes of this study, consecutive CKD patients stage 2-4 regularly followed in outpatient clinics of the Department of Nephrology, and fulfilling the inclusion/exclusion criteria, as well as controls without CKD, were invited to participate. All included patients signed a written informed consent form. The study protocol was approved by the Ethics Committee of the School of Medicine, Aristotle University of Thessaloniki. All procedures and evaluations are performed according to the Declaration of Helsinki 2013 Amendment.
Baseline evaluation includes the recording of demographics, anthropometric characteristics, CKD cause, comorbidities, concomitant medications, and a detailed physical examination. The Mini-Mental State Exam (MMSE) is used for the assessment of cognitive function; physical activity status is evaluated by the International Physical Activity Questionnaire. Study participants are advised to refrain from food, caffeine, alcohol, or tobacco for 12 h and received any standard medication before their morning appointment in the research laboratory to perform the assessments described below. BP measurements are performed thrice after 10 min of rest, in the sitting position, at the level of the brachial artery, with a validated oscillometric device [Omron M3 Intellisense (Omron Healthcare, Kyoto, Japan)] and a cuff of appropriate size, according to current guidelines. Afterwards, venous blood samples are collected for routine laboratory parameters. Office arterial stiffness and arterial wave parameters are measured with applanation tonometry using the Sphygmocor device (AtCor, Sydney, Australia). The common carotid intima-media thickness (cIMT) is measured with a 2D ultrasound device (GE Healthcare Ultrasound, Vivid S5, 8L-RS probe, USA) in the CCA between the middle and inner surface of the right and left artery wall, which is represented by a dense double-line pattern. Next, the participant is connected to the experimental apparatus for assessment of muscle and cerebral oxygenation via NIRS (Artinis, The Netherlands). The NIRS device is placed: a) on the forearm of the dominant limb for non-invasive monitoring of skeletal muscle oxygenation (absolute values and relative changes from baseline for oxygenated, deoxygenated, and total hemoglobin as well as tissue saturation index (TSI), as an absolute parameter for muscle oxygenation), and b) over the prefrontal cortex (contra-laterally of the dominant arm), 2 cm beside the midline and about 3 cm above the supraorbital ridge for assessing cerebral oxygenation. In brief, after calibration, with the participant in the seated position, baseline values are obtained, and a 5-minute arterial occlusion is performed. The cuff is rapidly inflated to suprasystolic levels (ie, 250 mm Hg), to obstruct blood flow to forearm muscles and measure the maximal capacity for oxygen extraction by skeletal muscles. Stable blood flow/volume is verified by total hemoglobin. The cuff is then rapidly deflated, and reoxygenation responses are recorded. After a subsequent 10-minute rest, the participant's maximal voluntary contraction (MVC) is assessed, using a digital dynamometer (K-Force, K-invent), followed by a 3-minute submaximal handgrip exercise test (set of 30 s exercise at 35% MVC with 3 s rest). The participant has visual feedback to maintain the force output to the predetermined MVC percentage. At the completion of the exercise protocol, the Rate of Perceived Exertion (RPE) is assessed using the the Borg scale. Continuous beat-by-beat SBP/DBP are recorded by photo-plethysmography (Finometer pro, Finapres Medical Systems, Amsterdam, The Netherlands) throughout the protocol.
研究の種類
入学 (実際)
連絡先と場所
研究場所
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Thessaloniki、ギリシャ、54642
- Department of Nephrology, Hippokration Hospital
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Age>18 years
- Patients with CKD stage 2, 3a, 3b, 4 (CKD-EPI eGFR: <90 and ≥30mL / min / 1.73m2) and controls without CKD
- Provision of informed written signed consent prior to study entry
Exclusion Criteria:
- Kidney transplant recipients
- Myocardial infarction or unstable angina episode within the past 3 months, or congestive heart failure class III-IV according to New York Heart Association criteria
- Patients with history of stroke, dementia or other severe neurologic disorders (e.g. Parkinson's disease, multiple sclerosis, etc)
- Patients with severe mental disorders
- History of drug or alcohol abuse
- Patients with muscle disorders
- Active malignant disease or other comorbidity with poor prognosis
- Active infection or relevant inter-current illness
- Pregnancy
研究計画
研究はどのように設計されていますか?
デザインの詳細
コホートと介入
グループ/コホート |
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CKD patients stage 2
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CKD patients stage 3a
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CKD patients stage 3b
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CKD patients stage 4
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Controls without CKD
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in skeletal muscle oxygen saturation (TSI%) at rest.
時間枠:Baseline
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Baseline
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二次結果の測定
結果測定 |
時間枠 |
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle TSI slope during occlusion
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle TSI magnitude during occlusion
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle oxygen consumption during occlusion
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in the hyperemia range (calculated as the difference between maximal TSI during reperfusion and rest TSI)
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle TSI slope during reperfusion
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle TSI magnitude during reperfusion
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (TSI change from baseline)
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (O2Hb change from baseline)
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (HHb change from baseline)
時間枠:Baseline
|
Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in muscle total blood volume during a 3-min handgrip exercise (35% of maximal voluntary capacity) (tHb change from baseline)
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in cerebral oxygenation at rest (TSI)
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in cerebral oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (TSI change from baseline)
時間枠:Baseline
|
Baseline
|
Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in cerebral oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (O2Hb change from baseline)
時間枠:Baseline
|
Baseline
|
Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in cerebral oxygenation during a 3-min handgrip exercise (35% of maximal voluntary capacity) (HHb change from baseline)
時間枠:Baseline
|
Baseline
|
Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in cerebral total blood volume during a 3-min handgrip exercise (35% of maximal voluntary capacity) (tHb change from baseline)
時間枠:Baseline
|
Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in office pulse wave velocity.
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in office augmentation pressure and augmentation index.
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in office central systolic and diastolic blood pressure
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in office brachial systolic and diastolic blood pressure
時間枠:Baseline
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Baseline
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Differences between CKD stages (stage 2, 3a, 3b and 4) and controls in carotid intima-media thickness
時間枠:Baseline
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Baseline
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協力者と研究者
出版物と役立つリンク
一般刊行物
- Theodorakopoulou MP, Schoina M, Sarafidis P. Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes. Am J Nephrol. 2020;51(12):931-949. doi: 10.1159/000512263. Epub 2020 Dec 11.
- Dipla K, Triantafyllou A, Koletsos N, Papadopoulos S, Sachpekidis V, Vrabas IS, Gkaliagkousi E, Zafeiridis A, Douma S. Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients: Links With Vascular Stiffness. Hypertension. 2017 Aug;70(2):444-451. doi: 10.1161/HYPERTENSIONAHA.117.09558. Epub 2017 Jun 12.
- Moody WE, Edwards NC, Madhani M, Chue CD, Steeds RP, Ferro CJ, Townend JN. Endothelial dysfunction and cardiovascular disease in early-stage chronic kidney disease: cause or association? Atherosclerosis. 2012 Jul;223(1):86-94. doi: 10.1016/j.atherosclerosis.2012.01.043. Epub 2012 Feb 2.
- Kintiraki E, Dipla K, Triantafyllou A, Koletsos N, Grigoriadou I, Poulakos P, Sachpekidis V, Vrabas IS, Zafeiridis A, Bili E, Douma S, Goulis DG. Blunted cerebral oxygenation during exercise in women with gestational diabetes mellitus: associations with macrovascular function and cardiovascular risk factors. Metabolism. 2018 Jun;83:25-30. doi: 10.1016/j.metabol.2018.01.009. Epub 2018 Feb 2.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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