Age, functional status, and survival benefit from kidney transplantation

肾移植对年龄、功能状态和生存的益处

• 批准号: 8187326
• 负责人: PETER PHILIP REESE
• 金额: $ 40万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8187326
• 关键词: Address; Affect; Age; Aging; Blood Vessels; Cessation of life; Characteristics; Clinical; Cohort Studies; Comorbidity; Counseling; Data; Data Set; Deterioration; Diabetes Mellitus; Dialysis patients; Dialysis procedure; Elderly; End stage renal failure; Excision; General Population; Geriatrics; Goals; Grant; Health; Individual; Kidney; Kidney Transplantation; Life; Link; Longevity; Measures; Medical; Morbidity - disease rate; Organ; Organ Transplantation; Outcome; Outcome Study; Patients; Physicians; Policies; Policy Developments; Policy Maker; Population; Predictive Value; Prevalence; Provider; Quality of life; Regulation; Relative Risks; Resources; Risk; Subgroup; Time; Transplantation; United Network for Organ Sharing; United States; Vascular Diseases; Waiting Lists; clinical decision-making; cohort; data registry; experience; functional status; high risk; human old age (65+); insight; interest; kidney allograft; mortality; novel; novel strategies; older patient; predictive modeling; tool

DESCRIPTION (provided by applicant): Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD), including for older patients with ESRD, but the scarcity of donated kidneys has focused interest on allocating transplants to the individuals who benefit the most. The growing and unmet need for kidney transplants is driven by the rising prevalence of ESRD in the United States. ESRD prevalence increased 70% from 1995 - 2005, with an even greater rate of rise among patients over 65 years old. Mortality for ESRD patients on dialysis is markedly elevated. For example, dialysis patients 65 - 69 years old live only 25% as long as individuals of the same age in the general population. Compared to dialysis, kidney transplantation leads to substantial improvements in survival and quality of life at all ages. However, older recipients gain fewer years of life from a kidney transplant compared to younger recipients. As a result, the United Network for Organ Sharing has advanced policy applications that would decrease access to kidney transplantation as patients get older. Collectively, these facts indicate that policy-makers and clinicians urgently need more accurate predictors of mortality among kidney transplant candidates and recipients to optimize the fair and efficient use of organs. The central premise of this grant is that functional status would act as a novel and accurate predictor of survival benefit from kidney transplantation. Recent insights from geriatric medicine reveal a strong relationship between better functional status and longer survival. Functional status can capture the cumulative impact of co-morbidities such as diabetes and vascular disease. Kidney transplant candidates often experience a high rate of morbidities while receiving years of dialysis, leading to temporary de-activation on the list, permanent removal, death, or poor survival after transplantation. Therefore, we will study whether functional status can be used to predict important differences in health between individuals with ESRD awaiting a transplant. Because functional status declines with aging even in healthy populations, we will also examine whether the predictive value of functional status differs between age strata. We propose a retrospective cohort study of kidney transplant candidates and recipients using a novel dataset that links registry data from the United Network for Organ Sharing and a large dialysis provider. The study will have the following specific aims: 1) To determine if functional status predicts survival among kidney transplant candidates and recipients; 2) To assess how age affects the relationship of functional status to survival among kidney transplant candidates and recipients; and 3) To determine if functional status predicts removal or inactivation on the waiting list for a kidney transplant. The results of this study have the potential to inform policy development related to allocating the scarce resource of transplanted kidneys, and to help patients with ESRD and their physicians understand the relative risks and benefits of kidney transplantation for individuals of all ages. PUBLIC HEALTH RELEVANCE: End-stage kidney disease impairs quality of life, decreases survival and is increasingly common in the United States, particularly among older adults. Kidney transplantation offers the optimal treatment for most patients with end-stage kidney disease, but a profound shortage of organs for transplantation has driven strong interest in providing kidney transplants to the patients who benefit the most. This study will take the novel approach of using functional status - a measure of the ability to complete important daily activities - as a tool to predict which patients derive the greatest survival benefit from a kidney transplant.

描述（由申请人提供）：肾移植是终末期肾病（ESRD）的最佳治疗方法，包括老年ESRD患者，但捐赠肾脏的稀缺性使人们关注将移植分配给受益最大的个体。肾移植需求的增长和未满足是由美国ESRD患病率的上升所驱动的。从1995年到2005年，ESRD患病率增加了70%，65岁以上患者的患病率上升幅度更大。接受透析的ESRD患者的死亡率显著升高。例如，65 - 69岁的透析患者的寿命仅为普通人群中同龄人的25%。与透析相比，肾移植可显著改善所有年龄段的生存率和生活质量。然而，与年轻的接受者相比，老年接受者从肾移植中获得的寿命更少。因此，器官共享联合网络已经推进了政策应用，随着患者年龄的增长，这些政策应用将减少肾移植的机会。总的来说，这些事实表明，政策制定者和临床医生迫切需要更准确的肾移植候选人和受体死亡率预测，以优化器官的公平和有效利用。 这项资助的中心前提是，肾功能状态将作为肾移植生存获益的一个新的和准确的预测因子。老年医学的最新见解揭示了更好的功能状态和更长的生存期之间的密切关系。功能状态可以捕获合并症（如糖尿病和血管疾病）的累积影响。肾移植候选人在接受多年透析时通常会出现高发病率，导致名单上的暂时失活，永久移除，死亡或移植后生存率低。因此，我们将研究功能状态是否可以用来预测等待移植的ESRD患者之间的健康状况的重要差异。由于即使在健康人群中，功能状态也会随着年龄的增长而下降，因此我们还将研究功能状态的预测值是否在年龄层之间存在差异。 我们提出了一个回顾性队列研究的肾移植候选人和接受者使用一个新的数据集，链接注册数据从联合网络器官共享和一个大型透析提供商。该研究将有以下具体目标：1）确定功能状态是否预测肾移植候选人和接受者的生存率; 2）评估年龄如何影响肾移植候选人和接受者的功能状态与生存率的关系; 3）确定功能状态是否预测肾移植等待名单上的移除或失活。 这项研究的结果有可能为与分配移植肾稀缺资源相关的政策制定提供信息，并帮助终末期肾病患者及其医生了解所有年龄段个体肾移植的相对风险和益处。 公共卫生关系：终末期肾病损害生活质量，降低生存率，在美国越来越常见，特别是在老年人中。肾移植为大多数终末期肾病患者提供了最佳治疗，但移植器官的严重短缺促使人们对向受益最大的患者提供肾移植产生了浓厚的兴趣。这项研究将采用新的方法，使用功能状态-完成重要日常活动的能力-作为预测哪些患者从肾移植中获得最大生存益处的工具。