World Trade Center (WTC) RENAL
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Renal Impairment / Chronic Kidney Disease, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Nephrology / Urology |
| Healthy: | No |
| Age Range: | 40 - Any |
| Updated: | 7/27/2017 |
| Start Date: | July 2014 |
| End Date: | September 16, 2016 |
Renal and Cardiovascular Impairment in WTC Responders: Implications for Diagnosis and Treatment
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.
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.
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.
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.
Inclusion Criteria:
- WTC responders who were enrolled in the WTC-CHEST program.
- World Trade Center responders who are currently enrolled in the World Trade Center
Health Program-Clinical Center of Excellence, formerly known as the WTC Medical
Monitoring and Treatment Program
- Over the age of 39 years
Exclusion Criteria:
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