Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.657186
Title: Assessing associations between measures of reduced glomerular filtration rate, abnormal cardiovascular risk factors, and risk of cardiovascular morbidity and mortality
Author: Mafham, M.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2009
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Abstract:
This thesis considers the hypothesis that small reductions in glomerular filtration rate (GFR), across the population range, are associated with a clustering of cardiovascular risk factors and increased risk of cardiovascular disease and death. The performance of a new method of assessing GFR, in which total plasma iohexol clearance is measured using dried capillary blood spots, was examined in a cross-sectional study of 81 consecutive individuals undergoing routine measurement of GFR. The new blood spot iohexol clearance (BSIC) method (using 3 blood spot samples) assessed GFR accurately compared to traditional iohexol clearance using 3 timed plasma samples; while prediction equations to estimate GFR from blood creatinine and cystatin c concentration performed poorly. Among 106 participants with measurements of BSIC-GFR, and GFR estimated from blood creatinine and cystatin c concentration, one or more measures of GFR were positively correlated with blood high density lipoprotein cholesterol concentration, and were inversely correlated with blood concentrations of triglyceride, C-reactive protein, fibrinogen, and homocysteine. BSIC-GFR was not more strongly related to cardiovascular risk factors than GFR estimated from blood creatinine concentration (eGFR). Cystatin c based GFR was strongly related to measures of body fat, while no relationship was seen with the other GFR measures. In a meta-analysis of cohort studies assessing the relationship between eGFR and risk of death and cardiovascular events, which included 4 061 003 and 1 372 820 individuals for each outcome respectively, a 30% lower eGFR was associated with a 20-30% increase in risk of both outcomes, depending on the type of study examined. however, there was significant heterogeneity between the studies. Large scale studies in which GFR is accurately measured are needed. Using the new BSIC method for this purpose is potentially feasible, but further work is required to ensure accuracy when the blood sampling is completed by participants themselves.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.657186  DOI: Not available
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