54 research outputs found
Anemia and the onset of gout in a population-based cohort of adults: Atherosclerosis Risk in Communities study
Center-driven and clinically driven variation in US liver transplant maintenance immunosuppression therapy: A national practice patterns analysis
Center-driven and clinically driven variation in US liver transplant maintenance immunosuppression therapy: A national practice patterns analysis
Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154612/1/ajt15709.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154612/2/ajt15709_am.pd
Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis
Outcome implications of benzodiazepine and opioid co- prescription in kidney transplant recipients
The outcomes of benzodiazepine and opioid co- prescription are not well- defined in transplant populations. We examined linked national transplant registry and pharmaceutical records to characterize benzodiazepine and opioid use in the years before and after transplant in large US cohort of kidney transplant recipients (2007- 2016; NĂÂ =ĂÂ 98ĂÂ 620), and associations (adjusted hazard ratio, LCLaHRUCL) with death and graft failure. Among the cohort, 15.6% filled benzodiazepine prescriptions in the year before transplant, and 14.0% filled benzodiazepine prescriptions in the year after transplant (short- acting, 9.5%; long- acting, 3.3%; both 1.1%). Use of short- acting benzodiazepines in the year before transplant was associated with a 22% increased risk of death in the year after transplant (aHR, 1.081.221.38), while use of all classes in the year after transplant was associated with increased risk of death from >1 to 5ĂÂ years (aHR: short- acting 1.291.391.48; long- acting 1.121.251.40; both 1.461.742.07). Recipients who used benzodiazepines were also more likely to fill opioid prescriptions. Recipients who filled both classes of benzodiazepine and the highest level of opioids had a 2.9- fold increased risk of death compared to recipients who did not use either. Co- prescription of benzodiazepines and opioids in kidney transplant recipients is associated with increased mortality. Ongoing research is needed to understand mechanisms of risk relationships.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/2/ctr14005.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162821/1/ctr14005_am.pd
Racial differences in inflammation and outcomes of aging among kidney transplant candidates
Abstract
Background
Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor physical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels among end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes such as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may differ between AA and non-AA ESRD patients.
Methods
One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014â5/2017), and inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP]) were measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical Performance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and tested whether these associations differed by race (AA vs. non-AA).
Results
Non-AAs had lower levels of TNFR1 (9.7âng/ml vs 14.0âng/ml, pââ0.9) and CRP (4.7 Îźg/ml vs 4.9 Îźg/ml, pâ=â0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RRâ=â1.58, 95% CI:1.27â1.96, pâ<â0.001), TNFR1 (RRâ=â1.60, 95% CI:1.25â2.05, pâ<â0.001), CRP (RRâ=â1.41, 95% CI:1.10â1.82, pâ<â0.01), and inflammatory index (RRâ=â1.82, 95% CI:1.44â2.31, pâ<â0.001). The associations between elevated inflammatory markers and frailty were not present among AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL.
Conclusions
Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from prehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant.https://deepblue.lib.umich.edu/bitstream/2027.42/149150/1/12882_2019_Article_1360.pd
Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients
Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18â question Center for Epidemiologic Studiesâ Depression Scale (CESâ D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CESâ D scoreĂ >Ă 14) and frailty were associated with KT length of stay (LOS), deathâ censored graft failureĂ (DCGF), andĂ mortality. AtĂ KTĂ admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frailĂ (aORĂ =Ă 3.97, 95% CI: 2.28â 6.91, PĂ <Ă 0.001).Ă Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70â 2.08, PĂ <Ă 0.001) longer LOS, 6.20â fold (95% CI:1.67â 22.95, PĂ <Ă 0.01)Ă increased risk of DCGF, and 2.62â foldĂ (95% CI:1.03â 6.70, PĂ =Ă 0.04)Ă increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interactionĂ <Ă 0.001). Interventions aimed at reducing preâ KT depressive symptoms and frailty should be explored for their impact on postâ KT outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146305/1/ctr13391_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146305/2/ctr13391.pd
Center practice drives variation in choice of US kidney transplant induction therapy: a retrospective analysis of contemporary practice
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141776/1/tri13079_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141776/2/tri13079.pd
Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups
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