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

基本信息

批准号：
9752537
负责人：
Meera Nair Harhay
金额：
$ 18.43万
依托单位：
DREXEL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-10 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9752537
关键词：
Accreditation Age Aging American Biological Process 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 Intervention Studies Intuition K-Series Research Career Programs Kidney Kidney Diseases Kidney Transplantation Knowledge Literature Malnutrition Measures Memory National Institute of Diabetes and Digestive and Kidney Diseases Nephrology Organ Outcome Patient Recruitments Patient Self-Report Patient-Focused Outcomes Patients Pattern Pennsylvania Physical Function Physical therapy Physicians Probability Process Prospective cohort Provider Quality of life Renal Replacement Therapy Renal dialysis Renal function Research Research Methodology Risk Risk stratification Scientist Series Severities Signal Transduction Societies 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 improved functioning instructor mortality older patient patient oriented patient subsets prospective public health relevance research clinical testing tool transplant centers trend

项目摘要

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（由适用提供）：肾脏移植（KT）的最新趋势表明，较脆弱的患者正在等待接受肾脏移植，但移植提供者目前的工具或指导有限，可以使KT候选者风险分配。也许结果，许多候选人可能会在等待名单上灭活或死亡，而不是接受移植。器官的供应有限，KT的候选人必须经常等待几年才能接受移植。长时间暴露于肾功能不良的对患者健康的负面影响很复杂，包括慢性感染和血管计算，可能导致某些候补患者的钢铁降低速度，导致KT的率较低，而KT后的结果较低。该职业发展奖的目标是表征KT候选人健康下降的模式，并使用老化文献中的现有知识来实施指标，以确定在等待KT同时经历健康下降的KT候选者。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获HEDH下降的早期迹象，以便可以及时进行干预或替代性KT策略来改善患者的结果。这笔赠款的主要前提是，长期暴露于慢性肾脏疾病（CKD）和肾脏替代疗法导致许多KT候选者的健康下降加速，这一过程可能解释了几个差的候补候补名单结果，包括增加比例的候选者比例增加。我提出了一系列研究，以发现KT候选者的身体和认知功能下降的模式以及可能解释这种下降的生物学过程，以下具体目的：1）发现与高级CKD的CRIC研究中个人中的灭活，脱离，脱位和死亡的物理和认知功能的指标如何访问KT； 2）将物理和认知功能的纵向指标实施到对单个中心的候选者的移植评估中，以评估与不活动状态，脱位和死亡的关联； 3）将临床评估与客观的物理和认知指标进行比较，以预测预期的候补KT候选者队列中与不良移植相关的结果的能力。我是由NIH F-32赠款资助的临床讲师，并获得了内科和肾脏病的董事会认证，并且是宾夕法尼亚大学临床流行病学硕士学位。我还完成了美国移植协会在宾夕法尼亚大学认可的肾脏移植研究金。 NIDDK K-23职业发展奖将使我能够开发旨在优化弱势肾脏移植候选者评估和护理的研究，目的是作为肾脏和肾脏和肾脏移植领域的独立物理科学家和民族领导者做出持续和持久的研究贡献。

项目成果

期刊论文数量（18）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Physical Function in Kidney Transplantation: Current Knowledge and Future Directions.

DOI：
10.1007/s40472-020-00271-5
发表时间：
2020-06
期刊：
Current transplantation reports
影响因子：
2.1
作者：
Yang D;Robinson L;Selinski C;Bajakian T;Mejia C;Harhay MN
通讯作者：
Harhay MN

Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study.

DOI：
10.1111/tmi.12622
发表时间：
2016-01
期刊：
Tropical medicine & international health : TM & IH
影响因子：
0
作者：
Harhay MN;Harhay MO;Coto-Yglesias F;Rosero Bixby L
通讯作者：
Rosero Bixby L

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation.

DOI：
10.1371/journal.pone.0156532
发表时间：
2016
期刊：
PloS one
影响因子：
3.7
作者：
Harhay MN;Hill AS;Wang W;Even-Shoshan O;Mussell AS;Bloom RD;Feldman HI;Karlawish JH;Silber JH;Reese PP
通讯作者：
Reese PP

Serum creatinine elevation after switch to dolutegravir in a human immunodeficiency virus-positive kidney transplant recipient.

DOI：
10.1111/tid.12545
发表时间：
2016-08
期刊：
Transplant infectious disease : an official journal of the Transplantation Society
影响因子：
0
作者：
Lee DH;Malat GE;Bias TE;Harhay MN;Ranganna K;Doyle AM
通讯作者：
Doyle AM

Self-reported major mobility disability and mortality among cancer survivors.