Patterns and Implications of Functional Decline Among Kidney Transplant Candidates

肾移植候选者功能衰退的模式和影响

• 批准号: 8867668
• 负责人: Meera Nair Harhay
• 金额: $ 15.67万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-10 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8867668
• 关键词: Age; Aging; American; Board Certification; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinical; Clinical Trials; Cognitive; Cohort Studies; Comorbidity; Complex; Consensus; Data; Data Analyses; Data Collection; Diabetes Mellitus; Dialysis procedure; Elderly; Evaluation; Exposure to; Face; Fellowship; Female; Funding; Future; Goals; Grant; Health; Health Status; Heterogeneity; Hospitalization; Impaired cognition; Individual; Inferior; Inflammation; Internal Medicine; Intervention; Intuition; K-Series Research Career Programs; Kidney; Kidney Diseases; Kidney Transplantation; Knowledge; Left; Literature; Malnutrition; Measures; Memory; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Organ; Outcome; Patient Recruitments; Patient Self-Report; Patients; Pattern; Pennsylvania; Physical Function; Physical therapy; Physicians; Probability; Process; Provider; Quality of life; Renal Replacement Therapy; Renal function; Research; Research Methodology; Risk; Risk Management; Scientist; Series; Severities; Signal Transduction; Societies; Staging; Stratification; Subgroup; Systematic Bias; Testing; Time; Transplant Recipients; Transplantation; United States National Institutes of Health; Universities; Vascular calcification; Waiting Lists; adverse outcome; base; clinical epidemiology; cognitive function; cohort; experience; frailty; functional decline; global health; health care service utilization; high risk; improved; instructor; mortality; older patient; patient oriented; prospective; public health relevance; research clinical testing; tool; trend

 DESCRIPTION (provided by applicant): Recent trends in kidney transplantation (KT) indicate that more vulnerable patients are waiting to receive kidney transplants than ever before, but transplant providers currently have limited tools or guidance to risk-stratify KT candidates. Perhaps as a result, many candidates are likely to be inactivated or die on the waiting list instead of receiving a transplant. The supply of organs is limited, and candidates for KT must often wait for years before receiving a transplant. Prolonged exposure to poor kidney function has complex negative impacts on patient health, including chronic inflammation and vascular calcification, plausibly leading to steep rates of health decline in certain waitlisted patients tht result in lower rates of KT and inferior outcomes after KT. The goal of this career development award is to characterize patterns of health decline in KT candidates and implement metrics, using existing knowledge in the aging literature, to identify KT candidates who are experiencing accelerated health decline while awaiting KT. Given the heterogeneity of health status on the waitlist, it is imperative that clinicians have objective measures that capture early signs of healh decline so that timely interventions or alternative KT strategies can be implemented to improve patient outcomes. The central premise of this grant is that prolonged exposure to chronic kidney disease (CKD) and renal replacement therapy results in accelerated health decline in many KT candidates, a process that may explain several poor waitlist outcomes including the increasing proportion of inactivated candidates. I propose a series of studies to discover the patterns of decline in physical and cognitive function in KT candidates and the biologic processes that may explain this decline, with the following specific aims: 1) To discover how metrics of physical and cognitive function predict access to KT, inactivation, de-listing and death among individuals in the CRIC study with advanced CKD; 2) To prospectively implement longitudinal metrics of physical and cognitive function into the transplant evaluation of incident KT candidates at a single center in order to evaluate associations with inactive status, de-listing, and death; and 3) To compare clinician evaluation to objective physical and cognitive metrics on the ability to predict adverse transplant-related outcomes among a prospective cohort of waitlisted KT candidates. I am a clinical instructor currently funded by an NIH F-32 grant, with board certification in Internal Medicine and Nephrology and a Masters in Clinical Epidemiology from the University of Pennsylvania. I have also completed the American Transplant Society accredited kidney transplant fellowship at the University of Pennsylvania. This NIDDK K-23 Career Development Award will enable me to develop research aimed at optimizing the assessment and care of vulnerable kidney transplant candidates, with the goal of making ongoing and lasting research contributions as an independent physician-scientist and national leader in the fields of nephrology and kidney transplantation.

 描述（由申请人提供）：肾移植 (KT) 的最新趋势表明，等待接受肾移植的弱势患者比以往任何时候都多，但移植提供者目前对 KT 候选者进行风险分层的工具或指导有限。也许因此，许多候选者可能会在等待名单上失活或死亡，而不是接受移植。器官供应有限，KT 候选人通常必须等待数年才能接受移植。长期肾功能不佳对患者健康产生复杂的负面影响，包括慢性炎症和血管钙化，这可能会导致某些候补患者的健康状况急剧下降，从而导致 KT 率降低和 KT 后预后较差。该职业发展奖的目标是描述 KT 候选人健康衰退的模式，并利用老龄化文献中的现有知识实施指标，以确定在等待 KT 期间健康状况加速衰退的 KT 候选人。鉴于候补名单上健康状况的异质性，临床医生必须采取客观措施来捕捉健康下降的早期迹象，以便及时采取干预措施或替代 KT 策略来改善患者的治疗结果。这笔资助的核心前提是，长期接触慢性肾脏病 (CKD) 和肾脏替代治疗会导致许多 KT 候选者的健康状况加速恶化，这一过程可以解释一些不良的候补结果，包括失活候选者比例的增加。我提出了一系列研究，以发现 KT 候选者身体和认知功能下降的模式以及可以解释这种下降的生物过程，具体目标如下：1）探索 CRIC 研究中晚期 CKD 个体的身体和认知功能指标如何预测 KT 的获得、失活、除名和死亡； 2) 前瞻性地将身体和认知功能的纵向指标纳入单个中心的事件 KT 候选者的移植评估中，以评估与不活跃状态、除名和死亡的关联；和 3) 将临床医生的评估与客观的身体和认知指标进行比较，以评估在候补 KT 候选人的前瞻性队列中预测不良移植相关结果的能力。我是一名临床讲师，目前由 NIH F-32 拨款资助，拥有内科和肾脏病学委员会认证以及宾夕法尼亚大学临床流行病学硕士学位。我还在宾夕法尼亚大学完成了美国移植协会认可的肾移植奖学金。 NIDDK K-23 职业发展奖将使我能够开展旨在优化弱势肾移植候选人的评估和护理的研究，目标是作为独立的医师科学家和肾病学和肾移植领域的国家领导者做出持续和持久的研究贡献。