Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients.

Objectives: Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age-related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death-censored graft loss (DCGL) and mortality.

Frailty and Cognitive Function in Incident Hemodialysis Patients.

Background And Objectives: Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD.

Changes in Frailty After Kidney Transplantation.

Objectives: To understand the natural history of frailty after an aggressive surgical intervention, kidney transplantation (KT).

Design: Prospective cohort study (December 2008-March 2014).

Setting: Baltimore, Maryland.

Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis.

Background: Frailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate-perceived frailty-is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship.

Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups.

Background: Disparities in access to kidney transplantation (KT) remain inadequately understood and addressed. Detailed descriptions of patient attitudes may provide insight into mechanisms of disparity. The aims of this study were to explore perceptions of dialysis and KT among African American adults undergoing hemodialysis, with particular attention to age- and sex-specific concerns.

Trends in kidney transplant outcomes in older adults.

Objectives: To estimate mortality and death-censored graft loss according to year of kidney transplant (KT) between 1990 and 2011.

Design: Cohort study.

Setting: The Scientific Registry of Transplant Recipients (SRTR).

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

Background And Objectives: Disparities in kidney transplantation remain; one mechanism for disparities in access to transplantation (ATT) may be patient-perceived concerns about pursuing transplantation. This study sought to characterize prevalence of patient-perceived concerns, explore interrelationships between concerns, determine patient characteristics associated with concerns, and assess the effect of concerns on ATT.

Design, Setting, Participants, & Measurements: Prevalences of 12 patient-perceived concerns about pursuing transplantation were determined among 348 adults who recently initiated dialysis, recruited from 26 free-standing dialysis centers around Baltimore, Maryland (January 2009-March 2012).

Patient- and provider-reported information about transplantation and subsequent waitlisting.

Because informed consent requires discussion of alternative treatments, proper consent for dialysis should incorporate discussion about other renal replacement options including kidney transplantation (KT). Accordingly, dialysis providers are required to indicate KT provision of information (KTPI) on CMS Form-2728; however, provider-reported KTPI does not necessarily imply adequate provision of information. Furthermore, the effect of KTPI on pursuit of KT remains unclear.

Actual and perceived knowledge of kidney transplantation and the pursuit of a live donor.

Background: Live donor kidney transplantation (LDKT) remains underutilized, partly resulting from the challenges many patients face in asking someone to donate. Actual and perceived kidney transplantation (KT) knowledge are potentially modifiable factors that may influence this process. Therefore, we sought to explore the relationships between these constructs and the pursuit of LDKT.

Age and sex disparities in discussions about kidney transplantation in adults undergoing dialysis.

Objectives: To explore whether disparities in age and sex in access to kidney transplantation (KT) originate at the time of prereferral discussions about KT.

Design: Cross-sectional survey.

Setting: Outpatient dialysis centers in Maryland (n = 26).

Assessment of resident and fellow knowledge of the organ donor referral process.

Maximizing deceased donation rates can decrease the organ shortage. Non-transplant physicians play a critical role in facilitating conversion of potential deceased donors to actual donors, but studies suggest that physicians lack knowledge about the organ donation process. As residency and fellowship are often the last opportunities for formal medical training, we hypothesized that deficiencies in knowledge might originate in residency and fellowship.

Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study.

Background: Patients undergoing hemodialysis are at high risk of falls, with subsequent complications including fractures, loss of independence, hospitalization, and institutionalization. Factors associated with falls are poorly understood in this population. We hypothesized that insights derived from studies of the elderly might apply to adults of all ages undergoing hemodialysis; we focused on frailty, a phenotype of physiological decline strongly associated with falls in the elderly.

Correlates of elevated interleukin-6 and C-reactive protein in persons with or at high risk for HCV and HIV infections.

Background: HIV and hepatitis C virus (HCV) infections may increase interleukin-6 (IL-6) and C-reactive protein (CRP). However, relationships between inflammatory biomarkers, chronic viral infections, clinical factors, and behavioral factors remain poorly understood.

Methods: Using linear regression, we modeled cross-sectional associations between loge IL-6 or loge CRP levels and HCV, HIV, injection drug use, and comorbidity among 1191 injection drug users.

Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis.

Objectives: To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization.

Design: Prospective cohort study.

Setting: Single hemodialysis center in Baltimore, Maryland.

HIV infection, immune suppression, and uncontrolled viremia are associated with increased multimorbidity among aging injection drug users.

Background: Despite an increasing burden of age-associated non-AIDS outcomes, few studies have investigated the prevalence or correlates of multimorbidity among aging human immunodeficiency virus (HIV)-infected and epidemiologically comparable at-risk populations.

Methods: Among 1262 AIDS Linked to the IntraVenous Experience (ALIVE) study participants followed in a community-based observational cohort, we defined the prevalence of 7 non-AIDS-defining chronic conditions (diabetes, obstructive lung disease, liver disease, anemia, obesity, kidney dysfunction, and hypertension) using clinical and laboratory criteria. Ordinal logistic regression was used to model the odds of increased multimorbidity associated with demographic, behavioral, and clinical factors.

Influence of Perceived Secondary Stigma and Family on the Response to HIV Infection Among Injection Drug Users in Vietnam.

The full impact of secondary stigma (stigma directed at family) on an HIV-positive individual is unknown. This qualitative research explores perceptions of secondary stigma in the Vietnamese context and its influence on the ways in which an injection drug user (IDU) copes with HIV infection. Data on experiences learning one's HIV status, disclosure decisions, family reactions, and stigma from family and community were collected through in-depth interviews with 25 HIV-positive IDUs recruited through a health center in Thai Nguyen, Vietnam.

Factors associated with the perpetration of sexual violence among wine-shop patrons in Chennai, India.

With an estimated 2.5 million people living with HIV/AIDS, India has the third highest number of HIV-infected people in the world. Despite reductions in prevalence among the general population, the percentage of all infections occurring among Indian women is continuing to rise.