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。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 候选者通常必须等待数年才能接受移植，长期暴露在肾功能不佳的情况下。影响对患者健康的影响，包括慢性炎症和血管钙化，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 发生率较低和 KT 后的不良结果。该职业发展奖的目标是描述健康状况下降的模式。考虑到候补名单上健康状况的异质性，利用老龄化文献中的现有知识，确定 KT 候选者的健康状况是否正在加速恶化，因此必须采取客观措施来尽早捕获。迹象此项资助的核心前提是，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。这个过程可以解释一些不良的候补结果，包括失活候选人比例的增加，我提出了一系列研究来发现 KT 候选人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，如下。具体目标： 1)在 CRIC 研究中发现晚期 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应用于事件 KT 候选者的移植评估中在单一中心评估与不活跃状态、除名和死亡的关联；3) 为了将临床医生的评估与客观的身体和认知指标进行比较，以预测候补 KT 候选人的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 资助，拥有内科委员会认证。我还获得了宾夕法尼亚大学的肾脏病学和临床流行病学硕士学位。该 NIDDK K-23 职业发展奖将使我能够发展。研究旨在优化对弱势肾移植候选者的评估和护理，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。

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）

Sarcopenia and mortality among a population-based sample of community-dwelling older adults.

基于社区的老年人样本中的肌肉减少症和死亡率。

DOI：
发表时间：
2016-06
期刊：
影响因子：
0
作者：
Brown, Justin C;Harhay, Michael O;Harhay, Meera N
通讯作者：
Harhay, Meera N

Appendicular Lean Mass and Mortality among Prefrail and Frail Older Adults.

体弱前和体弱老年人的四肢瘦体重和死亡率。

DOI：
发表时间：
2017
期刊：
影响因子：
0
作者：
Brown, J C;Harhay, M O;Harhay, M N
通讯作者：
Harhay, M N

The Affordable Care Act and Trends in Insurance Coverage and Disease Awareness Among Non-elderly Individuals with Kidney Disease.

《平价医疗法案》以及非老年肾病患者的保险覆盖范围和疾病意识趋势。

DOI：
发表时间：
2019
期刊：
影响因子：
5.7
作者：
Harhay, Meera Nair;McKenna, Ryan M
通讯作者：
McKenna, Ryan M

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

全球健康状况对透析信号肾移植后早期再住院风险的测量。

DOI：
发表时间：
2016
期刊：
影响因子：
3.7
作者：
Harhay, Meera N;Hill, Alexander S;Wang, Wei;Even;Mussell, Adam S;Bloom, Roy D;Feldman, Harold I;Karlawish, Jason H;Silber, Jeffrey H;Reese, Peter P
通讯作者：
Reese, Peter P

Frailty and Cognitive Deficits Limit Access to Kidney Transplantation: Unfair or Unavoidable?

虚弱和认知缺陷限制了肾移植的机会：不公平还是不可避免？