Chronic kidney disease (CKD) affects 12% of the United States adult population and it doubles the risks for stroke and dementia. While small vessel ischemic disease is linked with both stroke and dementia in the general population, almost nothing is known about the risk factors for small vessel ischemic disease in the brain or the relation of small vessel ischemic disease to clinical outcomes in patients with CKD. We propose to characterize the physiological mechanisms that underlie the relationship between CKD, hypertension, and small vessel ischemic disease in the brain by conducting an ancillary study to SPRINT MIND. The Systolic Pressure INtervention Trial Memory and cognition IN Decreased hypertension (SPRINT MIND) is an NIH sponsored trial testing whether a strategy of lowering systolic blood pressure below current targets reduces incident dementia and brain small vessel ischemic disease. In this application entitled 'MIND the Kidneys', we propose to enrich the neuroimaging component of SPRINT MIND with 170 additional subjects with CKD, and to add novel measures of brain perfusion and perfusion reserve using state-of-the-art Arterial Spin Labeling.
Our specific aims complement and substantially extend the core aims of SPRINT MIND by evaluating whether CKD and hypertension therapy affect brain perfusion, and whether changes in brain perfusion correlate with cognitive outcomes. We have assembled a multi-disciplinary group of investigators to address these important and innovative aims.

Public Health Relevance

Chronic kidney disease affects 12% of the United States adult population and it doubles the risks for stroke and dementia. This project will investigate the relation between chronic kidney disease, hypertension therapy, brain perfusion and clinical outcomes using state-of-the-art brain imaging techniques. Results stemming from this proposal will be important for defining the risks and benefits of intensive hypertension therapy in patients with chronic kidney disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK092241-01A1
Application #
8295928
Study Section
Special Emphasis Panel (ZDK1-GRB-7 (J3))
Program Officer
Kusek, John W
Project Start
2012-05-01
Project End
2017-04-30
Budget Start
2012-05-01
Budget End
2013-04-30
Support Year
1
Fiscal Year
2012
Total Cost
$714,688
Indirect Cost
$182,915
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Jahanian, Hesamoddin; Ni, Wendy W; Christen, Thomas et al. (2014) Spontaneous BOLD signal fluctuations in young healthy subjects and elderly patients with chronic kidney disease. PLoS One 9:e92539
Coker, Laura H; Espeland, Mark A; Hogan, Patricia E et al. (2014) Change in brain and lesion volumes after CEE therapies: the WHIMS-MRI studies. Neurology 82:427-34