There are >400,000 older ESRD patients in the United States; adults over 55 are the fastest growing age group, and also the most challenging to treat and counsel. In older ESRD patients, risk prediction for patients undergoing the 2 available treatment modalities -- dialysis and kidney transplantation (KT) -- is based on generic metrics derived from national registries that cover patients of all ages and focus on one dichotomous endpoint (survival/death). These outcomes may be of limited relevance to older ESRD patients who are at high risk of adverse health outcomes of aging (AHOA). Novel risk prediction metrics developed in community-dwelling older adults may be uniquely suited to risk prediction among older ESRD patients. One potentially important metric is frailty, an independent syndrome of decreased physiologic reserve. Systemic inflammation is thought to mediate the association of frailty and AHOA due to increased vulnerability to stressors. Frailty is associated with doubling of dialysis mortality risk and a doubling of early KT allograft dysfunction. However, other outcomes are important for older ESRD patients. In response to dialysis and KT, older patients are at high risk for AHOA (cognitive dysfunction, ADL disability, depression, and low quality of life). We will test the following specific aims in 1 cohort of older dialysis initiates and 1 cohort of older KT recipients: (1) To estimate frailty trajectories and factors associated with frailty decline; (2) To determine the association of frailty and AHOA; and (3) To evaluate the inflammatory pathway between frailty to AHOA. We have designed a mentorship plan that includes in-depth course work in aging research and will be carried out in a well suited environment. The mentorship team includes expertise in aging research, kidney disease research, and mentorship of junior faculty. This team will help the candidate meet her career goals: (1) Widen experience in aging research; (2) Applying for and obtaining R01 grant funding; and (3) Improving treatment and outcomes of older ESRD patients. Our exploration of novel predictors and outcomes specific to older ESRD patients will directly benefit this population, and their providers, by informing risk prediction, helping guide clinical decision making, and possibly even providing insights into underlying biological processes.
Risk prediction in older end stage renal disease (ESRD) patients is currently based on generic metrics derived from national registries that cover patients of all ages and focus on 1 dichotomous endpoint (survival/death). However, the novel incorporation of age-specific metrics, such as frailty, systemic inflammation, and adverse health outcomes of aging, will greatly improve clinical decision-making in older adults considering kidney transplantation. The goal of this project is to develop a prediction model for adverse health outcomes of aging (cognitive dysfunction, ADL disability, depression and low quality of life) in a cohort of dialysis patients and a second cohort of KT recipients. Our exploration of novel predictors and outcomes specific to older ESRD patients will directly benefit this population, and their providers, by informing risk prediction, helping guide clinical decision making, and possibly even providing insights into underlying biological processes.
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|Buta, Brian; Choudhury, Parichoy Pal; Xue, Qian-Li et al. (2017) The Association of Vitamin D Deficiency and Incident Frailty in Older Women: The Role of Cardiometabolic Diseases. J Am Geriatr Soc 65:619-624|
|McAdams-DeMarco, Mara A; Ying, Hao; Olorundare, Israel et al. (2017) Individual Frailty Components and Mortality in Kidney Transplant Recipients. Transplantation 101:2126-2132|
|Tan, Jingwen; Bae, Sunjae; Segal, Jodi B et al. (2017) Warfarin Use And the Risk Of Stroke, Bleeding, And Mortality In Older Adults On Dialysis With Incident Atrial Fibrillation. Nephrology (Carlton) :|
|King, Elizabeth A; Bowring, Mary Grace; Massie, Allan B et al. (2017) Mortality and Graft Loss Attributable to Readmission After Kidney Transplantation: Immediate and Long-term Risk. Transplantation 101:2520-2526|
|McAdams-DeMarco, Mara A; Olorundare, Israel O; Ying, Hao et al. (2017) Frailty and Postkidney Transplant Health-Related Quality of Life. Transplantation :|
|McAdams-DeMarco, Mara A; Bae, Sunjae; Chu, Nadia et al. (2017) Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients. J Am Soc Nephrol 28:1575-1583|
|Ballew, Shoshana H; Chen, Yan; Daya, Natalie R et al. (2017) Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 69:228-236|
|McAdams-DeMarco, M A; Ying, H; Olorundare, I et al. (2016) Frailty and Health-Related Quality of Life in End Stage Renal Disease Patients of All Ages. J Frailty Aging 5:174-9|
|Cobb, Laura K; McAdams-DeMarco, Mara A; Gudzune, Kimberly A et al. (2016) Changes in Body Mass Index and Obesity Risk in Married Couples Over 25 Years: The ARIC Cohort Study. Am J Epidemiol 183:435-43|
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