Publications by authors named "Mara A McAdams-Demarco"
Central body fat distribution affects kidney function. Abdominal fat measurements using computed tomography (CT) may prove superior in assessing body composition-related kidney risk in living kidney donors. This retrospective cohort study including 550 kidney donors aimed to determine the association between CT-measured abdominal fat areas and kidney function before and after donor nephrectomy.
View Article and Find Full Text PDFBuilt environment and chronic kidney disease: current state and future directions.
Curr Opin Nephrol Hypertens
November 2024
Article Synopsis
- - The review highlights a knowledge gap regarding how neighborhood characteristics affect chronic kidney disease (CKD), especially identifying modifiable factors that can help in prevention strategies through interventions.
- - Recent research primarily focuses on social aspects of neighborhoods, with initial studies on the built environment showing mixed results, particularly concerning food deserts and their risk for CKD.
- - There is a call for further investigation using advanced study methods and diverse datasets to better understand the links between neighborhood factors and CKD, with the potential for utilizing electronic health records to support this research.
Developing real-world evidence from electronic health records (EHR) is vital to advancing kidney transplantation (KT). We assessed the feasibility of studying KT using the Epic Cosmos aggregated EHR data set, which includes 274 million unique individuals cared for in 238 US health systems, by comparing it with the Scientific Registry of Transplant Recipients (SRTR). We identified 69 418 KT recipients who underwent transplants between January 2014 and December 2022 in Cosmos (39.
View Article and Find Full Text PDFBackground: Kidney transplant (KT) candidates often experience hospitalizations, increasing their delirium risk. Hospitalizations and delirium are associated with worse post-KT outcomes, yet their relationship with pre-KT outcomes is less clear. Pre-KT delirium may worsen access to KT due to its negative impact on cognition and ability to maintain overall health.
View Article and Find Full Text PDFBackground: Fewer minoritized patients with end-stage kidney disease (ESKD) receive kidney transplantation (KT); efforts to mitigate disparities have thus far failed. Pinpointing the specific stage(s) within the transplant care continuum (being informed of KT options, joining the waiting list, to receiving KT) where disparities emerge among each minoritized population is pivotal for achieving equity. We therefore quantified racial and ethnic disparities across the KT care continuum.
View Article and Find Full Text PDFIntroduction: Dietary restrictions for patients with end-stage kidney disease (ESKD) are burdensome. Kidney transplantation (KT) candidates who lack neighborhood resources and are burdened by dietary restrictions may have decreased access to KT.
Methods: In our two-center prospective cohort study (2014-2023), 2471 ESKD patients who were evaluated for KT (candidates) reported their perceived burden of dietary restrictions (not at all, somewhat/moderately, or extremely bothered).
Background And Hypothesis: Early steroid withdrawal (ESW) is often preferred over conventional steroid maintenance (CSM) therapy for kidney transplant recipients with low immunological risks because it may minimize immunosuppression-related adverse events while achieving similar transplant outcomes. However, the risk-benefit balance of ESW could be less favorable in retransplant recipients given their unique immunological risk profile. We hypothesized that the association of ESW with transplant outcomes would differ between first-transplant and retransplant recipients.
View Article and Find Full Text PDFIntroduction: ChatGPT has shown the ability to answer clinical questions in general medicine but may be constrained by the specialized nature of kidney transplantation. Thus, it is important to explore how ChatGPT can be used in kidney transplantation and how its knowledge compares to human respondents.
Methods: We prompted ChatGPT versions 3.
Article Synopsis
- Post-transplant, sexual bother tends to decrease over the first three years, with a significant improvement in sexual activity, especially peaking one year after transplantation.
- It's important to address sexual health during kidney transplantation management, as it greatly influences the quality of life for patients both before and after the procedure.
Article Synopsis
- Adults living in deprived neighborhoods face socioeconomic challenges that reduce their chances of receiving live-donor and preemptive kidney transplants, with a significant impact based on race and ethnicity.
- A study analyzing over 403,000 kidney transplant candidates found that higher neighborhood deprivation correlated with lower transplant rates, particularly affecting Black candidates.
- Key socioeconomic factors, like income and education, were linked to higher chances of receiving transplants, highlighting the need for targeted efforts to address these disparities.
Article Synopsis
- - Older patients with kidney failure who have sleep disorders are at a significantly increased risk for various types of dementia, including vascular dementia, with over 50% of these patients experiencing sleep issues.
- - A study involving over 216,000 older patients revealed that 26.3% were diagnosed with sleep disorders, leading to higher incidences of dementia within five years compared to those without sleep issues.
- - For patients specifically diagnosed with obstructive sleep apnea, positive airway pressure (PAP) therapy appears to lower the risk of developing dementia, highlighting a potential intervention for this vulnerable group.
Article Synopsis
- - The study assesses the link between extreme heat events and the risk of death among patients on maintenance dialysis in the US, revealing that these patients may be particularly vulnerable to high temperatures.
- - Using data from the US Renal Data System, researchers analyzed 945,251 dialysis patients in urban areas from 1997 to 2016, finding a significant increase in mortality risk during humid-heat events, particularly in the Southeast region.
- - While the study indicates heightened mortality risk associated with extreme heat, it acknowledges limitations such as potential misclassification of exposure and not factoring in other environmental stresses like air pollution.
Article Synopsis
- Older adults with chronic kidney disease (CKD) have a higher risk of dying, and traditional factors don’t accurately predict this risk, which led researchers to explore frailty and cognitive impairment as predictors.
- The study analyzed data from individuals aged 60 and above to understand how frailty and cognitive function relate to CKD and whether these factors could enhance mortality risk predictions.
- Results showed that frailty significantly worsened cognitive function, and while it improved mortality predictions for those with CKD, cognitive impairment did not add any predictive value.
The rise in the mean age of the global population has led to an increase in older kidney transplant (KT) patients. This demographic shift, coupled with the ongoing organ shortage, requires a nuanced understanding of which older adults are most suitable for KT. Recognizing the increased heterogeneity among older adults and the limitations of solely relying on chronological age, there is a need to explore alternative aging metrics beyond chronological age.
View Article and Find Full Text PDFArticle Synopsis
- * The risk of dementia is even higher for older adults living in minority-dominant neighborhoods, which is 2.19 times greater compared to White individuals in predominantly White neighborhoods.
- * The study analyzed over 901,000 older adults from 2003 to 2019 and found that racial and ethnic segregation plays a critical role in the increased risk of dementia among minoritized adults with kidney failure.
With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65 y face when they undergo kidney or liver transplantation.
View Article and Find Full Text PDFImportance: Identifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT).
Objective: To assess whether segregation at the candidate's residential neighborhood and transplant center neighborhood is associated with access to LDKT.
Design, Setting, And Participants: In this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry.
Rationale & Objective: Coronavirus disease (COVID)-19 has likely impacted accessibility to transplantation services among older adults (age ≥65 years). We quantified the impact of COVID-19 on kidney transplantation access for older kidney-only candidates registered on the United States (US) kidney waitlist.
Study Design: Retrospective analysis of registry data.
Body mass index is often used to determine kidney transplant (KT) candidacy. However, this measure of body composition (BC) has several limitations, including the inability to accurately capture dry weight. Objective computed tomography (CT)-based measures may improve pre-KT risk stratification and capture physiological aging more accurately.
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- Recent advancements in medical technology and healthcare have improved kidney transplant outcomes for older recipients (≥65), but trends in their post-transplant survival rates are uncertain due to factors like cardiovascular disease and the COVID-19 pandemic.
- A study analyzed data from over 450,000 kidney transplant recipients (both older and younger) from 1990 to 2022, examining trends pre- and post-pandemic using statistical models to assess mortality and graft failure rates.
- Findings showed that while older recipients increased 19-fold over three decades, their mortality risk decreased leading up to the pandemic but worsened during it, suggesting that ongoing improvements in transplant outcomes may have been interrupted.
Article Synopsis
- * A study of 1,406 ILDKT recipients revealed that older patients showed increased mortality risk (hazard ratio: 2.07) but similar rates of delayed graft function (DGF) and length of stay (LOS) compared to younger counterparts.
- * The effects of age on transplant outcomes were consistent across both ILDKT and compatible living donor kidney transplant (CLDKT) groups, suggesting that age should not disqualify older patients from receiving ILDKT.
Rationale & Objective: Because of the high risk of waitlist mortality and posttransplant complications, kidney transplant (KT) patients may benefit from advance care planning (ACP) and palliative care consultation (PCC). We quantified the prevalence and racial disparities in ACP and PCC among KT candidates and recipients.
Study Design: Prospective cohort study.