A5046745171- Dialysis and Renal Disease Management
- Frailty in Older Adults
- Dementia and Cognitive Impairment Research
- Nutrition and Health in Aging
- Renal Transplantation Outcomes and Treatments
- Health Systems, Economic Evaluations, Quality of Life
- Geriatric Care and Nursing Homes
- Intensive Care Unit Cognitive Disorders
- Neurological Complications and Syndromes
- Renal and Vascular Pathologies
- Anesthesia and Neurotoxicity Research
- Air Quality and Health Impacts
- Anesthesia and Sedative Agents
- Palliative Care and End-of-Life Issues
- Organ Transplantation Techniques and Outcomes
- Sleep and related disorders
- Global Health Care Issues
- Muscle and Compartmental Disorders
- Bone and Joint Diseases
- Liver Disease and Transplantation
- Epilepsy research and treatment
- Climate Change and Health Impacts
- Transplantation: Methods and Outcomes
- Organ Donation and Transplantation
- Pregnancy and Medication Impact
Johns Hopkins University
2016-2025
Emory University
2025
Johns Hopkins Medicine
2018-2024
UCLouvain Saint-Louis Brussels
1997
Prehabilitation is the process of enhancing preoperative functional capacity to improve tolerance for upcoming stressor; it was associated with improved postoperative outcomes in a handful studies, but never evaluated transplantation. Kidney transplant (KT) candidates may be uniquely suited prehabilitation because they experience profound loss while waiting years on dialysis. To better understand feasibility and effectiveness KT, we conducted pilot study center-based candidates; this...
Frailty, a syndrome distinct from comorbidity and disability, is clinically manifested as decreased resistance to stressors present in up 35% of patient with ESKD. It associated falls, hospitalizations, poor cognitive function, mortality. Also, frailty outcomes after kidney transplant, including delirium Frailty likely also access transplantation, given its association on dialysis post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought...
Background Restoration of kidney function after transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such post-transplant improvements or they experience subsequent decline as age a functioning graft. Methods In this two-center cohort study, we assessed pretransplant frailty (Fried physical phenotype) and (Modified Mini-Mental State Examination) in adult recipients. To investigate potential short-...
Given the potential utility of frailty, a clinical phenotype decreased physiologic reserve and resistance to stressors, predict postkidney transplant (KT) outcomes, we sought understand perceptions practices regarding frailty measurement in US KT programs.
Background: Kidney transplantation (KT) candidates often present with multiple comorbidities. These patients also have a substantial burden of frailty, which is associated increased mortality. However, it unknown if frailty merely surrogate for comorbidity, itself an independent domain risk, or and comorbidity differential effects. Better understanding the interplay between these 2 constructs will improve clinical decision making in KT candidates. Objective: To test whether equally waitlist...
Frail kidney transplant (KT) recipients have higher risk of adverse post-KT outcomes. Yet, there is interest in measuring frailty at KT evaluation and then using this information for stratification. Given long wait times KT, may improve or worsen between KT. Patterns, predictors, outcomes associated with these changes are unclear.
<b><i>Background:</i></b> Frailty, originally characterized in community-dwelling older adults, is increasingly being studied and implemented for adult patients with end-stage kidney disease (ESKD) of all ages (&#x3e;18 years). Frailty prevalence manifestation are unclear younger adults (18–64 years) ESKD; differences likely exist based on whether the treated hemodialysis (HD) or transplantation (KT). <b><i>Methods:</i></b> We leveraged 3...
Frailty, a measure of physiologic reserve, is associated with poor outcomes and mortality among kidney transplant (KT) candidates recipients. There are no national estimates frailty in this population, which may help patient counseling resource allocation at centers. We studied 4616 KT 1763 recipients our multicenter prospective cohort from 2008-2018 Fried measurements. Using Scientific Registry Transplant Recipients (SRTR) data (KT = 560 143 243 508), we projected the prevalence (for...
Cognitive impairment is common among persons with chronic kidney disease (CKD), due in part to reduced function. Given that physical activity (PA) known mitigate cognitive decline, we examined whether associations between CKD stage and global/domain-specific function differ by PA.We leveraged 3223 participants (≥60 years of age) enrolled National Health Nutrition Examination Survey (NHANES, 2011-2014), at least one measure objective [immediate recall (CERAD-WL), delayed (CERAD-DR), verbal...
Older patients with ESRD who receive a kidney transplant (KT) may develop post-KT dementia and Alzheimer's disease (AD) associated their long-standing and/or neurotoxic immunosuppressant agents. To investigate this possibility, we studied 40,918 older (aged ≥55 years) KT recipients (January 1, 1999 to December 31, 2011) linked Medicare claims through the US Renal Data System. We estimated AD risk (cumulative incidence) factors these sequelae using competing risks models. of death-censored...
Background. Cognitive impairment is common in patients with end-stage renal disease and associated poor outcomes on dialysis. We hypothesized that cognitive might be an increased risk of all-cause graft loss (ACGL) kidney transplant (KT) recipients. Methods. Using the Modified Mini-Mental State (3MS) examination, we measured global function at KT hospital admission a prospective, 2-center cohort 864 candidates (August 2009 to July 2016). estimated association between pre-KT ACGL using Cox...
Abstract Depressive symptoms and frailty are each independently associated with morbidity mortality in kidney transplant ( KT ) recipients. We hypothesized that having both depressive would be synergistic worse than the independent effect of each. In a multicenter cohort study 773 recipients, we measured Fried phenotype modified 18‐question Center for Epidemiologic Studies‐Depression Scale CES ‐D). Using adjusted Poisson regression survival analysis, tested whether ‐D score > 14) were...
Abstract Background Frailty and cognitive impairment (CI) are associated often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. Methods Participants from the National Health Aging Trends Study were assessed annually (2011–2016) for frailty (Fried’s criteria) CI (bottom quintile clock drawing test or immediate delayed recall; proxy-report dementia diagnosis AD8 ≥ 2). We used Fine & Gray model to identify correlates onset before...
Black patients referred for kidney transplantation have surpassed many obstacles but likely face continued racial disparities before transplant. The mechanisms that underlie these are unclear. We determined the contributions of socioeconomic status (SES) and comorbidities as mediators to in listing transplant.We studied a cohort (n=1452 black; n=1561 white) with failure who were started transplant process (2009-2018). estimated direct indirect effects SES (self-reported income, education,...
Abstract Background Frailty predicts adverse post-kidney transplant (KT) outcomes, yet the impact of frailty assessment on center-level outcomes remains unclear. We sought to test whether centers assessing as part clinical practice have better pre- and post-KT in all adult patients (≥18 years) older (≥65 years). Methods In a survey US (11/2017–4/2018), 132 (response rate = 65.3%) reported their practices (frequency specific tool) at KT evaluation admission. Assessment frequency was...
Background: Cognition is a research priority for people living with chronic kidney disease (CKD), but identification of critical questions lacking. This study aimed to determine which cognition-related are most important CKD stakeholders. Methods: A modified Delphi technique 3 survey rounds was used. The sample included panels (People lived experience, Researchers, and Clinicians) recruited through international patient networks, societies, snowball sampling email invitations. Survey were...
BACKGROUND: Although cell therapy has emerged as a promising approach to promote neovascularization, its effects are mostly limited capillaries. To generate larger or stable vessels, layering of mural cells such smooth muscle (SMCs) pericytes is required. Recently, direct reprogramming approaches have been developed for generating SMCs. However, reprogrammed SMCs lack genuine features contractile SMCs, native SMC phenotype; thus, their therapeutic and vessel-forming potential in vivo was not...
Abstract Background Frailty is associated with poor outcomes in surgical patients including kidney transplant (KT) recipients. Transplant centers that measure frailty have better pre- and postoperative outcomes. However, clinical utility of existing tools low due to time constraints. To address this major barrier implementation the preoperative evaluation patients, we developed an abridged phenotype. Methods The phenotype was by simplifying 5 physical (PFP) components a two-center...
Background. Kidney transplant (KT) recipients have numerous risk factors for delirium, including those shared with the general surgical population (eg, age and major surgery) transplant-specific neurotoxic immunosuppression medications). Evidence has linked delirium to long-term dementia in older adults undergoing surgery. We sought characterize associated post-KT delirium. Methods. Using United States Renal Data System datasets, we identified 35 800 adult first-time KT ≥55 y. evaluated...
retest effects may be attributed to 'repeated content' in neuropsychological tests such as words word list-learning tests, or the 'testing context' which involves procedural memory and reduced test anxiety following repeated administration. Alzheimer's Disease (AD) severely impairs episodic memory, so longitudinal cognitive testing among people with dementia reveal relative contributions of content versus context testing. we used data from Critical Path Institute's repository placebo arm...
Physical frailty phenotype is characterized by decreased physiologic reserve to stressors and associated with poor outcomes, such as delirium mortality, that may result from post-kidney transplant (KT) inflammation. Despite a hypothesized underlying pro-inflammatory state, conventional measures of typically do not incorporate inflammatory biomarkers directly. Among KT candidates recipients, we evaluated the inclusion traditional physical components.Among 1154 recipients inflammation...
Background: Fine particulate matter (particulate with diameter <2.5 µm [PM2.5]) is associated CKD progression and may impact the health of patients living kidney failure. While older (aged ≥65 years) adults are most vulnerable to PM2.5, it unclear whether on dialysis at elevated risk mortality when exposed fine matter. Methods: Older initiating (2010–2016) were identified from US Renal Data System (USRDS). PM2.5 concentrations obtained NASA’s Socioeconomic Application Center (SEDAC)...