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Chronic kidney disease (CKD) and end-stage renal disease are highly prevalent in Taiwan. Cardiovascular disease (CVD) is the most common cause of death in children with CKD. Nitric oxide (NO) deficiency links CKD and CVD. Asymmetric dimethylarginine (ADMA), a NO synthase inhibitor, its level is increased in kidney disease and cardiovascular disease and serves as a methylation biomarker.
In addition to ADMA, uremic environment, hyperhomocysteinemia (Hcy) and oxidative stress may affect DNA methylation. S-adenosylmethionine (SAM) is an important human methyl donor. S-adenosylhomocysteine (SAH) is demethylated product. Methylenetetrahydrofolate reductase (MTHFR), a folate metabolism enzyme can regulate methylation pathway.
The investigators intend to examine whether ADMA, SAM/SAH ratio, Hcy, and MTHFR gene methylation can serve as biosignature to predict CVD in children with CKD children.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 2/study, control | Study group: children aged<18 years with chronic kidney disease Control group: children aged<18 years without chronic kidney disease Methylation biosignature, CKD staging, assessment of cardiovascular function, and traditional/uremia-related risk factors will be performed. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Methylation biosignature | Other | Methylation biosignature, CKD staging, assessment of cardiovascular function, and traditional/uremia-related risk factors will be performed. |
|
| Measure | Description | Time Frame |
|---|---|---|
| change from baseline level of asymmetric dimethylarginine (ADMA) at 24 months | at the time of enrollment, 6 months, 12 months, 18 months, and 24 months | from the time of enrollment, every 6 months, up to 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| change from the baseline health-related quality of life at 24 months | EQ-5D-Y instrument will be employed at the time of enrollment, 6 months, 12 months, 18 months, 24 months | from the time of enrollment, every 6 months, up to 24 months |
| change from the baseline ratio of SAM/SAH (S-adenosylmethionine /S-adenosylhomocysteine ) at 24 months |
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Inclusion Criteria:
Exclusion Criteria:
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Children aged <18 years visit pediatric nephrology clinic during study period
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| Name | Affiliation | Role |
|---|---|---|
| You-Lin Tain, MD, PhD | Chang Gung Memorial Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kaohsiung Chang Gung Memorial Hospital | Kaohsiung City | 833 | Taiwan |
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| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D002318 | Cardiovascular Diseases |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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at the time of enrollment, 6 months, 12 months, 18 months, 24 months |
| from the time of enrollment, every 6 months, up to 24 months |
| change from the baseline level of hyperhomocysteinemia (Hcy) at 24 months | at the time of enrollment, 6 months, 12 months, 18 months, 24 months | from the time of enrollment, every 6 months, up to 24 months |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |