? Hemodialysis vascular access dysfunction accounts for extensive morbidity, and is the greatest contributor to cost among patients with renal failure. Diabetics and African Americans (AA's) are disproportionately affected; however, reasons for this are unclear. ? The primary aims of the proposed study are 1) estimate the association between diabetes and AA race and arteriovenous fistula (AVF) survival; 2) explore whether factors associated with vessel location and primary cause of renal disease account for the relationship between diabetes and AA race and AVF survival; 3) determine if vein caliber and arterial resistance account for the association between diabetes and AA race and AVF survival, and 4) determine if inflammation accounts for the association between diabetes and AA race and AVF failure. ? Two parallel activities will be conducted to address our scientific aims. First we will use data from the Centers for Medicare and Medicaid end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project, United States Renal Data System (USRDS) and an established cohort from a Veterans' Affairs sponsored study of dialysis patients undergoing AVF placement to identify factors that might account for the association between diabetes and race and AVF survival. Second, we will recruit a cohort of 180 pre-dialysis patients preparing to undergo access placement from the clinics at Emory University, Emory Crawford Long Hospital, Grady Memorial Hospital and the Dialysis Access Center of Atlanta to ascertain if serum markers of inflammation account for the association between diabetes and AA race and access survival. The proposed studies aim to elucidate reasons for the disparities in vascular access survival among diabetics and AA's. ? ?

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
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Emory University
Internal Medicine/Medicine
Schools of Medicine
United States
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Wasse, Haimanot; Huang, Rong; Long, Qi et al. (2014) Very high-dose cholecalciferol and arteriovenous fistula maturation in ESRD: a randomized, double-blind, placebo-controlled pilot study. J Vasc Access 15:88-94
Wasse, Haimanot; Cardarelli, Francesca; De Staercke, Christine et al. (2013) Accumulation of retained nonfunctional arteriovenous grafts correlates with severity of inflammation in asymptomatic ESRD patients. Nephrol Dial Transplant 28:991-7
Wasse, Haimanot; Zhang, Rebecca; Johansen, Kirsten L et al. (2013) ESRD patients using permanent vascular access report greater physical activity compared with catheter users. Int Urol Nephrol 45:199-205
Wasse, Haimanot; Huang, Rong; Long, Qi et al. (2012) Efficacy and safety of a short course of very-high-dose cholecalciferol in hemodialysis. Am J Clin Nutr 95:522-8
Wasse, Haimanot; Naqvi, Nawazish; Husain, Ahsan (2012) Impact of Mast Cell Chymase on Renal Disease Progression. Curr Hypertens Rev 8:15-23
Wasse, Haimanot; Huang, Rong; Naqvi, Nawazish et al. (2012) Inflammation, oxidation and venous neointimal hyperplasia precede vascular injury from AVF creation in CKD patients. J Vasc Access 13:168-74
Lynch, Janet R; Wasse, Haimanot; Armistead, Nancy C et al. (2011) Achieving the goal of the Fistula First breakthrough initiative for prevalent maintenance hemodialysis patients. Am J Kidney Dis 57:78-89
Wasse, Haimanot; Cardarelli, Francesca; De Staercke, Christine et al. (2011) 25-hydroxyvitamin D concentration is inversely associated with serum MMP-9 in a cross-sectional study of African American ESRD patients. BMC Nephrol 12:24
Wasse, Haimanot; Rivera, Angel A; Huang, Rong et al. (2011) Increased plasma chymase concentration and mast cell chymase expression in venous neointimal lesions of patients with CKD and ESRD. Semin Dial 24:688-93
McClellan, William M; Wasse, Haimanot; McClellan, Ann C et al. (2010) Geographic concentration of poverty and arteriovenous fistula use among ESRD patients. J Am Soc Nephrol 21:1776-82

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