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: 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
• 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

 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.



项目成果

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
• 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

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

• DOI: 10.1016/j.jgo.2018.03.004
• 发表时间: 2018-09
• 期刊: Journal of geriatric oncology
• 影响因子: 3
• 作者: Brown JC;Harhay MO;Harhay MN
• 通讯作者: Harhay MN

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
• 作者: Lee DH;Malat GE;Bias TE;Harhay MN;Ranganna K;Doyle AM
• 通讯作者: Doyle AM