<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02226055</url>
  </required_header>
  <id_info>
    <org_study_id>UoECKDu1</org_study_id>
    <nct_id>NCT02226055</nct_id>
  </id_info>
  <brief_title>An Investigation Into the Cardiovascular Risk and Aetiology of CKDu in Sri Lanka</brief_title>
  <official_title>An Investigation Into the Cardiovascular Risk and Aetiology of CKDu in Sri Lanka</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Edinburgh</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Rajarata University, Sri Lanka</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Edinburgh</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      1. We hypothesise that CKDu patients will have increased arterial stiffness and thus&#xD;
           increased all-cause and cardiovascular mortality. The first objective of this study is&#xD;
           to recruit a cohort of ~ 50 CKDu patients who attend the CKDu clinic in Anuradhapura,&#xD;
           and measure their arterial stiffness using the TensioMed® Arteriograph™ (details below).&#xD;
           We will recruit an age, sex and blood pressure matched control group of healthy Sri&#xD;
           Lankans (consenting visitors with patients both to clinic and as inpatients), and if&#xD;
           possible, a second control group, similarly age, sex and blood pressure matched, who&#xD;
           have CKD of known causes and attend general renal clinic in Anuradhapura.&#xD;
&#xD;
        2. We hypothesise that detailed renal analysis will give insight into the aetiology of CKDu&#xD;
           in the North Central Province of Sri Lanka. The second objective of the study is to&#xD;
           recruit up to 250 CKDu patients and to characterize their disease profile using analysis&#xD;
           serum and urine renal biomarkers, exosomes, proteomics and DNA adducts.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Chronic kidney disease (CKD) is one of the leading causes of hospital admission, clinic&#xD;
      attendance and mortality in some provinces of Sri Lanka. In central and southern provinces&#xD;
      increased incidence is attributed to type-2 diabetes and hypertension; however, this is not&#xD;
      the case in North Central Province (NCP) where CKD of unknown aetiology (CKDu) is the&#xD;
      commonest diagnosis. A recent World Health Organisation (WHO) investigation concluded that at&#xD;
      least 8,000 people have CKDu2.&#xD;
&#xD;
      First recognized in the early nineties, much work has been done to try to characterise the&#xD;
      disease however results are conflicting. Most suggest male paddy farmers working in rural&#xD;
      areas of the NCP are worst affected, presenting in their fifth decade with end stage renal&#xD;
      failure. However, a recent WHO study revealed higher prevalence in females, although more&#xD;
      severe renal impairment was more common in men.&#xD;
&#xD;
      Risk factors include inhabiting NCP &gt; five years, inhabiting the 'dry zone', reduced BMI,&#xD;
      lower socio-economic class, and exposure to agrochemicals. There has been suggestion of a&#xD;
      genetic link although positive family history is limited to one generation, with no evidence&#xD;
      of mendelian progression. Epidemiological studies reveal a clustered geographical&#xD;
      distribution with areas such as Medawachchiya, Padaviya and Girandurukotte most affected.&#xD;
      High prevalence areas encompass a well-developed irrigation system used for agricultural&#xD;
      purposes.&#xD;
&#xD;
      Renal biopsies show tubulointerstitial disease with tubular atrophy, interstitial mononuclear&#xD;
      cell infiltration, interstitial fibrosis but no immune-complex deposition on&#xD;
      immunofluorescence. This supports a toxin-mediated process.&#xD;
&#xD;
      Many aetiologies have been considered including exposure to heavy metals (cadmium, arsenic)&#xD;
      and their chelation by herbicides, fluro-aluminium complexes, agricultural pesticides,&#xD;
      mycotoxins, and herbal medicines. Selenium deficiency and genetic susceptibility may be&#xD;
      predisposing factors. The true aetiology is likely multifactorial.&#xD;
&#xD;
      The multi-system impact of CKDu has yet to be fully realised. Epidemiological and clinical&#xD;
      data show that damage to large arteries contributes to the increased cardiovascular risk&#xD;
      observed in CKD. Atherosclerosis is the most frequent cause of arterial damage but the medial&#xD;
      calcification seen in CKD also leads to arterial stiffening. This stiffening causes elevation&#xD;
      in systolic blood pressure, increasing left ventricular workload with the gradual development&#xD;
      of LVH, and also a fall in diastolic blood pressure impairing coronary blood flow. Arterial&#xD;
      calcification and stiffness are independent predictors of all-cause and cardiovascular&#xD;
      mortality in patients with CKD. Arterial stiffness will be compared in CKDu patients, healthy&#xD;
      Sri Lankan controls and CKD patients both in Sri Lanka and Scotland.&#xD;
&#xD;
      We will perform a prospective observational study of up to 250 patients with CKDu presenting&#xD;
      to renal clinics in Teaching Hospital, Anuradhapura. Patient history, basic anthropometric&#xD;
      measurements, and simple non-invasive tests (e.g. blood pressure and arterial stiffness) will&#xD;
      be performed. Urine, serum and plasma samples will be collected for quantitative PCR, and&#xD;
      further analysis for biomarkers of renal injury, exosomes, proteomics and any DNA-adducts.&#xD;
      Patients will be graded using the WHO CKDu grading system. When a renal biopsy is performed,&#xD;
      a copy of the light microscopy findings will be obtained. Comparisons of interest will be&#xD;
      tested via paired t-tests with statistical significance taken at 5%.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date>September 2014</start_date>
  <completion_date type="Actual">May 1, 2017</completion_date>
  <primary_completion_date type="Actual">May 1, 2017</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Retrospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Arterial stiffness</measure>
    <time_frame>3 months</time_frame>
    <description>Arterial stiffness will be measured using the TensioMed® Arteriograph™. Damage to large arteries contributes to increased cardiovascular risk in CKD. Atherosclerosis is the most frequent cause of arterial damage but medial calcification seen in CKD also leads to arterial stiffening. This stiffening causes elevated systolic blood pressure, increased left ventricular workload and the gradual development of LVH, and also a fall in diastolic blood pressure impairing coronary blood flow. Arterial calcification and stiffness are independent predictors of all-cause and cardiovascular mortality in CKD patients. It is unclear whether the CVD risk associated with CKDu is the same as it is for CKD of known cause. We plan to measure arterial stiffness in both CKD and CKDu patients. We will compare stiffness measurements in CKD of unknown cause with those of a well characterised cohort of CKD patients in Edinburgh. Healthy Sri Lankan volunteers will give an assessment of 'background stiffness'.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Biomarkers of renal disease and DNA adducts</measure>
    <time_frame>3 months</time_frame>
    <description>As the aetiology of CKDu remains unknown, we will collect blood and urine samples from a cohort of p to 259 CKDu patients to explore the aetiology further. These samples will be analysed for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts.</description>
  </secondary_outcome>
  <number_of_groups>4</number_of_groups>
  <enrollment type="Actual">200</enrollment>
  <condition>CKDu</condition>
  <condition>Arterial Stiffness</condition>
  <condition>Proteinuria</condition>
  <condition>Serum Creatinine</condition>
  <condition>Urinary Biomarkers</condition>
  <condition>DNA Adducts</condition>
  <arm_group>
    <arm_group_label>Arterial stiffness: CKDu patients</arm_group_label>
    <description>Cohort of 50 patients with CKD of unknown aetiology Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Arterial stiffness: CKD known cause</arm_group_label>
    <description>Cohort of 50 patients with CKD of known cause Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Arterial Stiffness: Healthy Sri Lankan volunteers</arm_group_label>
    <description>Cohort of 50 participants who are healthy Sri Lankan volunteers Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>2nd aim: 250 CKDu patients for investigation of aetiology</arm_group_label>
    <description>To recruit a cohort of up to 250 CKDu patients from specific CKDu clinics in Anuradhapura and Padavi-Sri Pura for detailed history, basic anthropometric tests, and further analysis of serum, and urine. Analysis for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts will be used to seek information that may complement already collected data and help refine aetiological hypotheses.&#xD;
Inclusion and Exclusion criteria as per CKDu cases in cohort 1</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Arterial Stiffness Assessment</intervention_name>
    <description>The following will be measured: brachial systolic and diastolic bp, heart rate, mean arterial bp, pulse pressure, brachial augmentation index (difference between the amplitudes of the late (backward) systolic wave (P2) and the early (forward) systolic wave (P1) over the pulse pressure x 100), central augmentation, ejection duration of the left ventricle, return time (time of the pulse wave travelling from aortic root to the bifurcation and back), aortic pulse wave velocity ( velocity of the pulse wave in the aorta), central systolic bp, central pulse pressure and diastolic reflection area (provides information about the quality of diastolic filling in the coronary arteries).&#xD;
We will perform an arterial age assessment. Patients are given a feedback form with their results to give to their general. Those with increased arterial stiffness will be tested for serum calcium and phosphate levels, and audited to ensure that a statin is commenced if not contraindicated.</description>
    <arm_group_label>Arterial Stiffness: Healthy Sri Lankan volunteers</arm_group_label>
    <arm_group_label>Arterial stiffness: CKD known cause</arm_group_label>
    <arm_group_label>Arterial stiffness: CKDu patients</arm_group_label>
    <other_name>TensioMed® Arteriograph™</other_name>
    <other_name>Pulse wave velocity</other_name>
    <other_name>Arterial Stiffness Monitor</other_name>
  </intervention>
  <biospec_retention>Samples With DNA</biospec_retention>
  <biospec_descr>
    <textblock>
      Urine samples: up to 30ml Blood samples: up to 40ml - 2 x EDTA blood bottles + 2 x serum gel&#xD;
      Z bottles&#xD;
    </textblock>
  </biospec_descr>
  <eligibility>
    <study_pop>
      <textblock>
        Patients attending clinics or admitted to hospital during Aug 2014 to Oct 2014 with CKDu&#xD;
        (Chronic kidney disease of unknown origin).&#xD;
&#xD;
        Subjects must be aged 18 to 85 with evidence of renal dysfunction and no other obvious&#xD;
        cause noted (see inclusion/exclusion criteria above).&#xD;
&#xD;
        Control groups will be sought for the measure of arterial stiffness: Sri Lankan CKD of&#xD;
        known cause, Sri Lankan healthy volunteers. Our controls will be age, sex and blood&#xD;
        pressure matched to the cases.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        CKDu (CKD unknown aetiology) patients:&#xD;
&#xD;
        Inclusion Criteria&#xD;
&#xD;
          -  Age 18- 85 years&#xD;
&#xD;
          -  Attend CKDu clinic in Anuradhapura or Padavi-Sri Pura&#xD;
&#xD;
          -  Evidence of renal dysfunction: proteinuria, raised serum creatinine&#xD;
&#xD;
          -  Able to understand information given and happy to give consent&#xD;
&#xD;
        Exclusion Criteria&#xD;
&#xD;
          -  Subjects who are on dialysis&#xD;
&#xD;
          -  History of diabetes&#xD;
&#xD;
          -  History of major cardiac (including MI), respiratory (including asthma &amp; COPD) or&#xD;
             neurological disease&#xD;
&#xD;
          -  Pregnant&#xD;
&#xD;
          -  History of significant hypertension (&gt;140/90mmHg despite anti-hypertensives or&#xD;
             &gt;160/100mmHg untreated)&#xD;
&#xD;
          -  History of glomerulonephritis or other known cause of renal disease&#xD;
&#xD;
        Inclusion criteria for healthy volunteers:&#xD;
&#xD;
          -  Age 18- 85 years&#xD;
&#xD;
          -  Present in Anuradhapura teaching hospital as a visitor/carer of patient in ward or at&#xD;
             outpatient clinic at either site&#xD;
&#xD;
          -  Able to understand information given and happy to give consent&#xD;
&#xD;
        Exclusion criteria for healthy volunteers:&#xD;
&#xD;
          -  Age &lt; 18 or &gt;85 years&#xD;
&#xD;
          -  Evidence of renal dysfunction: proteinuria, raised serum creatinine&#xD;
&#xD;
          -  Evidence of diabetes mellitus, significant hypertension (defined above),&#xD;
             glomerulonephritis or other known cause of renal disease.&#xD;
&#xD;
        Inclusion criteria for patients with CKD of known cause:&#xD;
&#xD;
          -  Age 18- 85 years&#xD;
&#xD;
          -  Attend general renal clinic in Anuradhapura or Padavi-Sri Pura&#xD;
&#xD;
          -  Evidence of renal dysfunction: proteinuria, raised serum creatinine&#xD;
&#xD;
          -  Known cause renal disease proven by biopsy or strong association such as diabetes&#xD;
             mellitus or chronic, severe hypertension.&#xD;
&#xD;
          -  Able to understand information given and happy to give consent&#xD;
&#xD;
        Exclusion criteria for patients with CKD of known cause:&#xD;
&#xD;
          -  Age &lt; 18 or &gt;85 years&#xD;
&#xD;
          -  CKD unknown origin&#xD;
&#xD;
          -  Pregnant&#xD;
&#xD;
          -  Subjects who are on dialysis&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>85 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Michael Eddleston, MA PhD FRCPEdin</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Edinburgh</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Neeraj Dhaun, PhD MRCP</last_name>
    <role>Study Director</role>
    <affiliation>University of Edinburgh</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Sisira Siribaddana, MD FCCP</last_name>
    <role>Study Director</role>
    <affiliation>Rajarata University, Sri Lanka</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Teaching Hospital Anuradhapura</name>
      <address>
        <city>Anuradhapura</city>
        <state>North Central Province</state>
        <zip>A13</zip>
        <country>Sri Lanka</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Sri Lanka</country>
  </location_countries>
  <link>
    <url>http://dh-web.org/health/ckdu/review-JCCGP.pd</url>
    <description>Clinical review CKDu</description>
  </link>
  <link>
    <url>http://www.biomedcentral.com/1471-2369/14/180</url>
    <description>WHO + Sri Lankan Ministry of Health collaborative study</description>
  </link>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pubmed/12615661</url>
    <description>Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol. Apr 1 2003;23(4):554-566</description>
  </link>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pubmed/14581387</url>
    <description>Sarnak MJ, Levey AS et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research,</description>
  </link>
  <verification_date>October 2017</verification_date>
  <study_first_submitted>August 25, 2014</study_first_submitted>
  <study_first_submitted_qc>August 25, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">August 26, 2014</study_first_posted>
  <last_update_submitted>October 30, 2017</last_update_submitted>
  <last_update_submitted_qc>October 30, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">November 1, 2017</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Chronic kidney disease of unknown origin</keyword>
  <keyword>Chronic kidney disease of unknown aetiology</keyword>
  <keyword>Sri Lanka</keyword>
  <keyword>CKDu</keyword>
  <keyword>Arterial stiffness</keyword>
  <keyword>Cardiovascular risk</keyword>
  <keyword>North Central Province</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Proteinuria</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02226055
org study id: UoECKDu1
nct id: NCT02226055
lead sponsor: 
collaborator: 
has dmc: No
1. We hypothesise that CKDu patients will have increased arterial stiffness and thus
           increased all-cause and cardiovascular mortality. The first objective of this study is
           to recruit a cohort of ~ 50 CKDu patients who attend the CKDu clinic in Anuradhapura,
           and measure their arterial stiffness using the TensioMed® Arteriograph™ (details below).
           We will recruit an age, sex and blood pressure matched control group of healthy Sri
           Lankans (consenting visitors with patients both to clinic and as inpatients), and if
           possible, a second control group, similarly age, sex and blood pressure matched, who
           have CKD of known causes and attend general renal clinic in Anuradhapura.

        2. We hypothesise that detailed renal analysis will give insight into the aetiology of CKDu
           in the North Central Province of Sri Lanka. The second objective of the study is to
           recruit up to 250 CKDu patients and to characterize their disease profile using analysis
           serum and urine renal biomarkers, exosomes, proteomics and DNA adducts.
Chronic kidney disease (CKD) is one of the leading causes of hospital admission, clinic
      attendance and mortality in some provinces of Sri Lanka. In central and southern provinces
      increased incidence is attributed to type-2 diabetes and hypertension; however, this is not
      the case in North Central Province (NCP) where CKD of unknown aetiology (CKDu) is the
      commonest diagnosis. A recent World Health Organisation (WHO) investigation concluded that at
      least 8,000 people have CKDu2.

      First recognized in the early nineties, much work has been done to try to characterise the
      disease however results are conflicting. Most suggest male paddy farmers working in rural
      areas of the NCP are worst affected, presenting in their fifth decade with end stage renal
      failure. However, a recent WHO study revealed higher prevalence in females, although more
      severe renal impairment was more common in men.

      Risk factors include inhabiting NCP > five years, inhabiting the 'dry zone', reduced BMI,
      lower socio-economic class, and exposure to agrochemicals. There has been suggestion of a
      genetic link although positive family history is limited to one generation, with no evidence
      of mendelian progression. Epidemiological studies reveal a clustered geographical
      distribution with areas such as Medawachchiya, Padaviya and Girandurukotte most affected.
      High prevalence areas encompass a well-developed irrigation system used for agricultural
      purposes.

      Renal biopsies show tubulointerstitial disease with tubular atrophy, interstitial mononuclear
      cell infiltration, interstitial fibrosis but no immune-complex deposition on
      immunofluorescence. This supports a toxin-mediated process.

      Many aetiologies have been considered including exposure to heavy metals (cadmium, arsenic)
      and their chelation by herbicides, fluro-aluminium complexes, agricultural pesticides,
      mycotoxins, and herbal medicines. Selenium deficiency and genetic susceptibility may be
      predisposing factors. The true aetiology is likely multifactorial.

      The multi-system impact of CKDu has yet to be fully realised. Epidemiological and clinical
      data show that damage to large arteries contributes to the increased cardiovascular risk
      observed in CKD. Atherosclerosis is the most frequent cause of arterial damage but the medial
      calcification seen in CKD also leads to arterial stiffening. This stiffening causes elevation
      in systolic blood pressure, increasing left ventricular workload with the gradual development
      of LVH, and also a fall in diastolic blood pressure impairing coronary blood flow. Arterial
      calcification and stiffness are independent predictors of all-cause and cardiovascular
      mortality in patients with CKD. Arterial stiffness will be compared in CKDu patients, healthy
      Sri Lankan controls and CKD patients both in Sri Lanka and Scotland.

      We will perform a prospective observational study of up to 250 patients with CKDu presenting
      to renal clinics in Teaching Hospital, Anuradhapura. Patient history, basic anthropometric
      measurements, and simple non-invasive tests (e.g. blood pressure and arterial stiffness) will
      be performed. Urine, serum and plasma samples will be collected for quantitative PCR, and
      further analysis for biomarkers of renal injury, exosomes, proteomics and any DNA-adducts.
      Patients will be graded using the WHO CKDu grading system. When a renal biopsy is performed,
      a copy of the light microscopy findings will be obtained. Comparisons of interest will be
      tested via paired t-tests with statistical significance taken at 5%.
observational model: Cohort
time perspective: Retrospective
measure: Arterial stiffness
time frame: 3 months
description: Arterial stiffness will be measured using the TensioMed® Arteriograph™. Damage to large arteries contributes to increased cardiovascular risk in CKD. Atherosclerosis is the most frequent cause of arterial damage but medial calcification seen in CKD also leads to arterial stiffening. This stiffening causes elevated systolic blood pressure, increased left ventricular workload and the gradual development of LVH, and also a fall in diastolic blood pressure impairing coronary blood flow. Arterial calcification and stiffness are independent predictors of all-cause and cardiovascular mortality in CKD patients. It is unclear whether the CVD risk associated with CKDu is the same as it is for CKD of known cause. We plan to measure arterial stiffness in both CKD and CKDu patients. We will compare stiffness measurements in CKD of unknown cause with those of a well characterised cohort of CKD patients in Edinburgh. Healthy Sri Lankan volunteers will give an assessment of 'background stiffness'.
measure: Biomarkers of renal disease and DNA adducts
time frame: 3 months
description: As the aetiology of CKDu remains unknown, we will collect blood and urine samples from a cohort of p to 259 CKDu patients to explore the aetiology further. These samples will be analysed for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts.
arm group label: Arterial stiffness: CKDu patients
description: Cohort of 50 patients with CKD of unknown aetiology Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.
arm group label: Arterial stiffness: CKD known cause
description: Cohort of 50 patients with CKD of known cause Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.
arm group label: Arterial Stiffness: Healthy Sri Lankan volunteers
description: Cohort of 50 participants who are healthy Sri Lankan volunteers Inclusion and exclusion criteria below Measure of arterial stiffness using pulse wave velocity technology Assessment of BMI, central and brachial blood pressure, arterial stiffness and 'arterial age' will be made and fed back to the patient. this information will be given in a 'results sheet' that the participant will be encouraged to give to their Gp for further treatments required.
arm group label: 2nd aim: 250 CKDu patients for investigation of aetiology
description: To recruit a cohort of up to 250 CKDu patients from specific CKDu clinics in Anuradhapura and Padavi-Sri Pura for detailed history, basic anthropometric tests, and further analysis of serum, and urine. Analysis for biomarkers of kidney damage, proteomics, exosomes, and DNA adducts will be used to seek information that may complement already collected data and help refine aetiological hypotheses.
Inclusion and Exclusion criteria as per CKDu cases in cohort 1
intervention type: Device
intervention name: Arterial Stiffness Assessment
description: The following will be measured: brachial systolic and diastolic bp, heart rate, mean arterial bp, pulse pressure, brachial augmentation index (difference between the amplitudes of the late (backward) systolic wave (P2) and the early (forward) systolic wave (P1) over the pulse pressure x 100), central augmentation, ejection duration of the left ventricle, return time (time of the pulse wave travelling from aortic root to the bifurcation and back), aortic pulse wave velocity ( velocity of the pulse wave in the aorta), central systolic bp, central pulse pressure and diastolic reflection area (provides information about the quality of diastolic filling in the coronary arteries).
We will perform an arterial age assessment. Patients are given a feedback form with their results to give to their general. Those with increased arterial stiffness will be tested for serum calcium and phosphate levels, and audited to ensure that a statin is commenced if not contraindicated.
arm group label: Arterial Stiffness: Healthy Sri Lankan volunteers
arm group label: Arterial stiffness: CKD known cause
arm group label: Arterial stiffness: CKDu patients
other name: TensioMed® Arteriograph™
other name: Pulse wave velocity
other name: Arterial Stiffness Monitor
Urine samples: up to 30ml Blood samples: up to 40ml - 2 x EDTA blood bottles + 2 x serum gel
      Z bottles
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: 85 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Michael Eddleston, MA PhD FRCPEdin
role: Principal Investigator
affiliation: University of Edinburgh
last name: Neeraj Dhaun, PhD MRCP
role: Study Director
affiliation: University of Edinburgh
last name: Sisira Siribaddana, MD FCCP
role: Study Director
affiliation: Rajarata University, Sri Lanka
facility: 
country: Sri Lanka
url: http://dh-web.org/health/ckdu/review-JCCGP.pd
description: Clinical review CKDu
url: http://www.biomedcentral.com/1471-2369/14/180
description: WHO + Sri Lankan Ministry of Health collaborative study
url: http://www.ncbi.nlm.nih.gov/pubmed/12615661
description: Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol. Apr 1 2003;23(4):554-566
url: http://www.ncbi.nlm.nih.gov/pubmed/14581387
description: Sarnak MJ, Levey AS et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research,
responsible party type: Sponsor
mesh term: Proteinuria
sharing ipd: No