Volume And Patient-Oriented Research in Chronic Kidney Disease (VAPOR-CKD) - PROJECT SUMMARY Approximately 14% of the US adult population has chronic kidney disease (CKD), which is a potent risk factor for heart failure (HF) and cardiovascular (CV) death. Similarly, among patients who survive long enough to develop kidney failure requiring hemodialysis, CV disease remains the leading cause of death. In addition to being at risk of so-called traditional CV risk factors, patients across the spectrum of kidney disease are at risk from numerous non-traditional risk factors, which likely contribute to their poor outcomes. Our group has been particularly interested in hypervolemia, a common complication among these patients, which is also known to be associated with other adverse CV outcomes (e.g., left ventricular hypertrophy, myocardial ischemia, and hypertension). Despite decades of experience, clinicians remain largely reliant on the clinical exam to assess volume status among patients with kidney disease. Given the known challenges to accurately assess volume by these means, there is an urgent need to investigate contemporary point-of-care tools that can provide more objective assessments of true volume status. Our group has developed expertise in the use and interpretation of bioimpedance, with prior reports observing an association of shorter vector length (a proxy for hypervolemia) as an independent risk factor for adverse CV outcomes among patients with CKD and among patients receiving maintenance HD. However, whether longitudinal measures of vector length could provide additional prognostic benefit, or even reduce the frequency of volume-related adverse events, remains unclear and inadequately tested. In Aim 1, using longitudinal bioimpedance data from CRIC and FHN, we will employ contemporary statistical methods to examine the incremental predictive capacity of changes in volume with heart failure, CV, and kidney outcomes. In Aim 2 we propose a pilot randomized controlled trial to test the hypothesis that the provision of bioimpedance data (vs. not) will result in a lower frequency of volume-related adverse events among patients receiving HD. The proposals in this K24 Midcareer Investigator Award will expand the research portfolio of Dr. Mc Causland’s group, provide robust training experiences for mentees, foster new and consolidate existing collaborations, and provide multiple opportunities for future studies. Our proposals are clinically relevant, feasible, and innovative, and have the potential to reduce the risk of adverse CV events among patients with CKD and those requiring HD.
