World Trade Center (WTC) RENAL
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|ClinicalTrials.gov Identifier: NCT02246101|
Recruitment Status : Completed
First Posted : September 22, 2014
Last Update Posted : July 26, 2017
Environmental toxins exert damaging health effects in workers. Thousands of responders who worked or volunteered on the World Trade Center (WTC) rescue and recovery effort following the September 11, 2001 attacks suffer from health conditions or may be at increased risk for worsening health. In a pilot study, investigators identified the first evidence of kidney damage in subjects with very high exposure at Ground Zero. Specifically, noted was a preliminary association between the intensity of particulate matter exposure and albuminuria, a marker of early chronic kidney disease (CKD), systemic endothelial dysfunction, and increased cardiovascular risk.
The long-term goal is to minimize the risk of CKD and cardiovascular disease (CVD) among individuals exposed to inhaled toxins. The primary objective of this research is to quantify the risk of kidney damage among first responders to the WTC attack and to determine the relationship to particulate matter exposure as well as determine an association between renal and cardiovascular damage in first responders and to explore potential mechanisms. The central hypothesis is that exposure to inhaled particulate matter causes systemic inflammation and endothelial dysfunction that result in chronic kidney and cardiovascular damage. This hypothesis will be investigated in a subgroup of participants from a previously conducted NIOSH-funded study "Pulmonary Function Abnormalities, Diastolic Dysfunction and WTC Exposure: Implications for Diagnosis and Treatment" ("WTC-CHEST," PI Mary Ann McLaughlin).
The proposed study will capitalize on unique resources in WTC-CHEST, including the standardized collection of data on particulate matter exposure and shared risk factors for CKD and cardiovascular disease, and cardiopulmonary function testing. The output from this proposal is anticipated to have a broad impact on understanding the health effects of inhaled particulate matter.
|Condition or disease|
|Cardiac Disease Cardiopulmonary Disease Renal Disease Cardiovascular Disease|
Specific Aim 1. To quantify the risk of kidney damage and the relationship to particulate matter exposure among first responders to the WTC attack.
Urine samples will be collected on 2 occasions for albumin and creatinine. The investigators will define clinically relevant albuminuria as a UACR ≥30 mg/g. If, as hypothesized, the investigators find that albuminuria is more common among WTC responders, this simple and non-invasive measure may be useful in monitoring programs to identify responders at increased risk for adverse outcomes. eGFR will be calculated using the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equations.
Specific Aim 2. To examine the relationship between kidney damage and cardiac structure and function among first responders to the WTC attack.
Cardiovascular Disease Risk Screening In order to identify an independent relationship between CKD and cardiac dysfunction, the investigators will comprehensively evaluate potential confounders. Participants will undergo an evaluation of traditional CVD risk factors as accounted for in both the Framingham Risk Score and Reynold's score (medical history, medication use and baseline risk for CVD: smoking status, family history of premature coronary disease, blood pressure, heart rate, height, weight, waist, hip and neck circumference). Laboratory evaluation will include: lipid panel, complete blood count, HbA1C, serum creatinine and cystatin C. Standard questionnaires on chest pain, shortness of breath, depression, sleep apnea and stress, IPSS.
Specific Aim 3. To explore potential mechanisms for kidney and cardiovascular damage among first responders to the WTC attack.
An established marker of systemic inflammation, serum hsCRP, will be measured in all participants. Flow-mediated dilatation, a validated non-invasive measure of endothelial function, will be measured in a subgroup of participants. Heavy metal assays will be performed and will be compared between participants with and without evidence of kidney damage (albuminuria or decreased eGFR) or proximal tubular dysfunction.
|Study Type :||Observational|
|Actual Enrollment :||406 participants|
|Official Title:||Renal and Cardiovascular Impairment in WTC Responders: Implications for Diagnosis and Treatment|
|Study Start Date :||July 2014|
|Actual Primary Completion Date :||September 16, 2016|
|Actual Study Completion Date :||September 16, 2016|
WTC responders who were enrolled in the WTC-CHEST program.
- Estimated Glomerular Filtration Rate (eGFR) [ Time Frame: Day 1 ]Kidney Function - To quantify the risk of kidney damage and the relationship to particulate matter exposure among first responders to the WTC attack.
- Echocardiography [ Time Frame: Day 1 ]Cardiac structure - To examine the relationship between kidney damage and cardiac structure and function among first responders to the WTC attack.
- Urine Albumin level [ Time Frame: Day 1 ]Cardiac function - To examine the relationship between kidney damage and cardiac structure and function among first responders to the WTC attack.
- High Sensitivity C-reactive Protein (hsCRP) [ Time Frame: Day 1 ]Endothelial Dysfunction - To explore potential mechanisms for kidney and cardiovascular damage among first responders to the WTC attack.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02246101
|United States, New York|
|Icahn School of Medicine at Mount Sinai|
|New York, New York, United States, 10029|
|Principal Investigator:||Mary Ann McLaughlin, MD, MPH||Icahn School of Medicine at Mount Sinai|