Predicting mortality after kidney transplantation: a clinical tool

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71914/1/j.1432-2277.2005.00212.x.pd

A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant

Background: Functional disability is defined as the need for assistance with self-care tasks. Objective: To document changes in functional status over time among older prevalent renal transplant recipients. Design: Single center, prospective, follow-up study. Setting: Single center, tertiary care transplant center. Patients: Patients, with a functioning kidney transplant, aged 65 years or older who underwent assessment of functional status approximately 12 months previously. Measurements: Validated tools used included Barthel Index, the Lawton-Brody Scale of Instrumental Activities of Daily Living, the Timed Up and Go test, the Veterans Specific Activity Questionnaire, the Mini-Cog, and dynamometer handgrip strength. Methods: Outpatient assessment by a trained observer. Results: Of the 82 patients previously studied, 64 (78%) patients participated in the follow-up study (mean age 70.5 ± 4.4 years, 58% male, 55% diabetic). Among those completing functional status measures, 32 (50%) had functional disability at baseline. Over the 1-year period, 11 (17%) of these patients experienced progressive functional decline, 6 (9%) exhibited no change, and 15 (23%) had functional recovery. Eleven patients (17%) initially independent, developed new-onset disability. One of the strongest predictors of progressive functional decline was having 1 or more falls in the previous year. Limitations: Assessments were performed only on 2 occasions separated by approximately 1 year. Conclusions: Fluctuations in disability states are common among older adults living with renal transplants. Episodes of functional disability may place individuals at higher risk of persistent and/or progressive disability

Impact of Age on Peritonitis Risk in Peritoneal Dialysis Patients: An Era Effect

Background and objectives: Despite reductions in the frequency of peritoneal dialysis (PD)-related infectious complications over time, peritonitis and catheter infection remain important causes of morbidity and mortality. Given the increasing number of elderly patients reaching end-stage renal disease, making informed decisions about PD utilization is contingent on an understanding of the infectious complications of PD in this population. We therefore studied the impact of age on infection rates, organisms and outcomes

Predictors of Peritonitis in Patients on Peritoneal Dialysis: Results of a Large, Prospective Canadian Database

Background and objectives: Despite the decreasing incidence of peritonitis among peritoneal dialysis (PD) patients over time, its occurrence is still associated with significant morbidity and mortality. Determining factors that are associated with PD peritonitis may facilitate the identification of patients who are at risk

2017_Suppl_2_Assessment_Tools – Supplemental material for A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant

<p>Supplemental material, 2017_Suppl_2_Assessment_Tools for A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant by Kevin Yau, Janine F. Farragher, S. Joseph Kim, Olusegun Famure and Sarbjit V. Jassal in Canadian Journal of Kidney Health and Disease</p

2017_Suppl_1yr_transplant_yau_r1_Table_2 – Supplemental material for A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant

<p>Supplemental material, 2017_Suppl_1yr_transplant_yau_r1_Table_2 for A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant by Kevin Yau, Janine F. Farragher, S. Joseph Kim, Olusegun Famure and Sarbjit V. Jassal in Canadian Journal of Kidney Health and Disease</p

A prospective 2-site parallel intervention trial of a research-based film to increase exercise amongst older hemodialysis patients

Abstract Background Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease. Methods/Design This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients’ exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community. Discussion This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation’s guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients. Trial registration NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016