Impact of climate change on cognitive and physical aging of older kidney transplant recipients

气候变化对老年肾移植受者认知和身体衰老的影响

• 批准号: 10838643
• 负责人: Mara A. McAdams DeMarco
• 金额: $ 12.13万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10838643
• 关键词: Acceleration; Acute; Address; Adult; Age; Aging; Air Pollution; Area; Characteristics; Chronic Disease; Clinical; Cognitive; Cognitive aging; Data; Data Set; Dehydration; Delirium; Dementia; Dependence; Dialysis procedure; Dimensions; Elderly; Electrolytes; End stage renal failure; Epidemiology; Event; Exposure to; Glean; Goals; Health; Heat Waves; Hurricane; Ice; Immune system; Immunosuppression; Impaired cognition; Individual; Injury; Kidney Diseases; Kidney Transplantation; Lead; Length of Stay; Link; Lower Extremity; Measures; Metabolism; Modeling; National Institute on Aging; National Oceanic and Atmospheric Administration; Neighborhoods; Operative Surgical Procedures; Outcome; Parents; Patients; Personal Satisfaction; Phenotype; Physical Function; Physical Performance; Physical activity; Physiological; Population; Prospective, cohort study; Research; Risk; Risk Estimate; Risk Factors; Role; Science; Temperature; Testing; Trail Making Test; Training; Transplant Recipients; Transplantation; Transplanted Kidney Complication; United States National Aeronautics and Space Administration; United States National Institutes of Health; Vulnerable Populations; ambient air pollution; climate change; climate impact; climate-related health; cognitive function; cohort; comorbidity; delayed graft function; environmental change; epidemiology study; experience; extreme weather; fall injury; falls; fine particles; frailty; graft function; hospital readmission; instrumental activity of daily living; interest; mortality; novel; older patient; prevent; sociodemographics; socioeconomics; systemic inflammatory response

Kidney transplantation (KT) is increasingly a treatment option for older (≥65) patients end-stage kidney disease and KT recipients experience accelerated physical and cognitive aging due to years of reliance on dialysis, as well as chronic disease comorbidity and immunosuppression to prevent graft loss. This has led us to explore novel risk factors like climate change that may cause accelerated physical/cognitive aging and post- KT outcomes. We hypothesize that various dimensions of climate change may cause accelerated physical/cognitive aging and post-KT clinical outcomes among KT recipients and specifically older recipients. First, rising ambient temperatures and frequent heatwaves lead to increased dehydration, hyperosmolality, and electrolyte imbalances, all of which are known risks of graft loss and mortality. Our preliminary study shows that exposure to high PM2.5 level, a cause of systemic inflammation, increases post-KT mortality 15%. The meteorological interactions between climate change and air pollution may exacerbate the adverse impacts. Second, older KT recipients are most vulnerable to climate change due to a lower physiological reserve, slower metabolism, and decreased immune system. Air pollution and heatwaves may increase the risk for delirium as well as cognitive declines which are the prevalent post-KT complications. Lastly, extreme weather events, such as hurricane and ice storm, can increase risks for injuries and falls, especially among older adults with limited physical functioning. To study climate change and health (CCH) in KT, we will leverage our ongoing prospective cohort study, Frailty Assessment in Renal Disease (FAIR), which captures pre- and post-KT measures of physical/cognitive aging and post-KT clinical outcomes on 1,469 adult (age≥18) KT recipients residing in 39 states. We will glean 4 markers of climate change (long-term temperature change, heatwaves, extreme weather events, and ambient air pollution levels) from publicly available data from the US National Oceanic and Atmospheric Administration, National Aeronautics, and Space Administration Socioeconomic Data and Applications Center. We will conduct a health effects epidemiology, one of the Core Pillars of CCH/Diverse Areas of Science identified by the NIH. This supplement is highly relevant to CCH because we seek to: 1. Quantify the impact of climate change on physical aging among KT recipients; 2. Test whether climate change is associated with cognitive aging among KT recipients. 3. Estimate the risk of post-KT clinical outcomes among recipients who experience climate change. The parent K02 proposal incorporates training goals to establish novel risk factors for cognitive and physical functioning among KT recipients, and our findings will enhance the K02 goals by incorporating novel aging risk factors, namely climate changes. This supplement addresses a topic of interest to the National Institute on Aging: short- and long-term health impacts of extreme weather and climate change on the health and wellbeing of older adults in the US.

肾移植 (KT) 日益成为老年（≥65 岁）终末期肾病患者的一种治疗选择 由于多年的依赖，疾病和 KT 接受者经历了身体和认知加速老化 透析，以及慢性疾病合并症和免疫抑制，以防止移植物丢失。 探索气候变化等新的风险因素，这些因素可能会导致身体/认知老化加速和后遗症 我们认为气候变化的各个方面都可能导致加速。 KT 接受者（特别是老年接受者）的身体/认知衰老和 KT 后临床结果。 首先，环境温度升高和频繁的热浪会导致脱水、高渗性和 电解质失衡，所有这些都是已知的移植物丢失和死亡风险。 暴露于高 PM2.5 水平（导致全身炎症）会使 KT 后死亡率增加 15%。 气候变化和空气污染之间的气象相互作用可能会加剧不利影响。 其次，老年 KT 接受者由于生理储备较低、速度较慢，最容易受到气候变化的影响。 新陈代谢和免疫系统下降可能会增加谵妄的风险。 以及认知能力下降，这是 KT 后常见的并发症。最后，极端天气事件，例如。 飓风和冰暴等灾害可能会增加受伤和跌倒的风险，尤其是对于行动能力有限的老年人而言。 为了研究 KT 的气候变化与健康 (CCH)，我们将利用我们正在进行的研究。 前瞻性队列研究，肾病虚弱评估 (FAIR)，记录了 KT 前后的情况 对 1,469 名成人（年龄≥18）KT 接受者的身体/认知衰老和 KT 后临床结果的测量 我们居住在 39 个州，将收集气候变化的 4 个标志（长期温度变化、热浪、 极端天气事件和环境空气污染水平）来自美国国家航空航天局的公开数据 海洋和大气管理局、国家航空航天局 社会经济 我们将开展数据和应用中心的健康影响流行病学研究，这是该研究的核心支柱之一。 CCH/NIH 确定的不同科学领域 本补充品与 CCH 高度相关，因为我们。 寻求： 1. 量化气候变化对 KT 接受者身体衰老的影响 2. 测试是否； 气候变化与 KT 接受者的认知衰老有关。 3. 估计 KT 后临床风险。 经历气候变化的受助者的成果母 K02 提案纳入了培训。 目标是建立 KT 接受者认知和身体功能的新风险因素，以及我们的 研究结果将通过纳入新的老龄化风险因素（即气候变化）来增强 K02 目标。 补充材料涉及国家老龄化研究所感兴趣的主题：短期和长期健康影响 极端天气和气候变化对美国老年人健康和福祉的影响。