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Bulbul E, Namoglu SS. The frailty in older hemodialysis patients and associations with depression, functional status, dialysis adequacy. Ther Apher Dial 2024. [PMID: 38828537 DOI: 10.1111/1744-9987.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The aim of this study was to determine the level of frailty in older hemodialysis patients and to examine the relationship between their functional capacity, depression, and laboratory variables. METHOD This was a cross-sectional study, and the data were collected 243 dialysis patients aged 65 and over between May 2021 and May 2022. RESULTS The frailty rate was 49%. A statistically significant positive correlation was found between the frailty and age, hemodialysis vintage, and the number of hospitalizations. The frailty was negatively correlated with body mass index, Kt/V, Albumin, and parathyroid hormone. There was a statistically significant positive correlation between frailty and depression and a negative correlation between functional capacity. CONCLUSION A relationship was found between frailty and depression, functional capacity, and laboratory variables. In addition, the variables affecting the level of frailty in geriatric dialysis patients included dialysis vintage, dialysis adequacy, number of hospitalizations, albumin level, and patient weight.
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Affiliation(s)
- Elif Bulbul
- Internal Medicine Nursing Department, Istanbul, Turkey
| | - Selda Selimoglu Namoglu
- Dialysis Department, Istanbul Medipol University, Health Vocational School, Istanbul, Turkey
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Kennard AL, Glasgow NJ, Rainsford SE, Talaulikar GS. Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD. Kidney Int Rep 2024; 9:791-806. [PMID: 38765572 PMCID: PMC11101734 DOI: 10.1016/j.ekir.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 05/22/2024] Open
Abstract
Frailty is a multidimensional clinical syndrome characterized by low physical activity, reduced strength, accumulation of multiorgan deficits, decreased physiological reserve, and vulnerability to stressors. Frailty has key social, psychological, and cognitive implications. Frailty is accelerated by uremia, leading to a high prevalence of frailty in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as well as contributing to adverse outcomes in this patient population. Frailty assessment is not routine in patients with CKD; however, a number of validated clinical assessment tools can assist in prognostication. Frailty assessment in nephrology populations supports shared decision-making and advanced communication and should inform key medical transitions. Frailty screening and interventions in CKD or ESKD are a developing research priority with a rapidly expanding literature base.
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Affiliation(s)
- Alice L. Kennard
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas J. Glasgow
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Suzanne E. Rainsford
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Girish S. Talaulikar
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
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Taylor KS, Novick TK, Santos SR, Chen Y, Smith OW, Perrin NA, Crews DC. Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use. KIDNEY360 2023; 4:1590-1597. [PMID: 37943037 PMCID: PMC10695650 DOI: 10.34067/kid.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023]
Abstract
Key Points Food insecurity and housing instability may affect dialysis outcomes through health behaviors like treatment adherence and their effect on access to transplantation or home dialysis therapies. People on hemodialysis who were younger, with less educational attainment, with lower incomes, or experiencing financial strain were more likely to experience material need insecurities. Participant race was not associated with material need insecurities, although residential segregation moderated associations between age, sex, and food insecurity. Background Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population. Methods We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington, DC metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual-level and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models. Results Of the 305 participants who completed study surveys, 57% were men and 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes, or experiencing financial strain were more likely to have material need insecurities (P < 0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared with women (odds ratio 3.7; 95% confidence interval, 1.61 to 8.53); younger participants (age <55 years) had increased odds of food insecurity compared with older participants (odds ratio 3.3; 95% confidence interval, 1.49 to 7.32). Associations between sex or younger age category and food insecurity were not statistically significant in less segregated counties (P interaction for residential segregation×sex: P = 0.006; residential segregation×younger age category: P = 0.12). Conclusions Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3
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Affiliation(s)
| | - Tessa K. Novick
- University of Texas at Austin Dell Medical School, Austin, Texas
| | - Sydney R. Santos
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Owen W. Smith
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nancy A. Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zhang H, Hao M, Li Y, Hu Z, Liu Z, Jiang S, Jin L, Wang X. Assessment of Physical Resilience Using Residual Methods and Its Association With Adverse Outcomes in Older Adults. Innov Aging 2023; 7:igad118. [PMID: 38024329 PMCID: PMC10652184 DOI: 10.1093/geroni/igad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives Physical resilience (PR) is recognized as the ability to recover from the adverse effects of a stressor. However, there is a lack of consensus on how to optimally measure PR in older adults in general. We aimed to measure PR using residuals from regression analyses and investigated its association with adverse outcomes in older adults. Research Design and Methods A total of 6 508 older adults were included from the National Health and Aging Trends Study, which was a population-based prospective cohort study. PR was assessed using residual methods from a linear model regressing the short physical performance battery on clinical diseases, age, sex, race/ethnicity, and health condition. Adverse outcomes included all-cause mortality, falls, and overnight hospitalization. Results The mean age was 77.48 (7.84) years. Increased PR was associated with a lower risk of all-cause mortality (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.83-0.87). Compared to participants with reduced PR, those with normal PR had a lower risk for mortality (HR = 0.51, 95% CI: 0.46-0.56). Specifically, restricted cubic spline regression revealed a dose-response relationship between PR and all-cause mortality (p-overall < .0001, p-nonlinear = .011). Additionally, we also found significant associations of increased PR with lower risks of falls (HR = 0.98, 95% CI: 0.96-0.99) and overnight hospitalization (HR = 0.98, 95% CI: 0.97-1.00). Discussion and Implications PR, measured by residual methods, was robustly and independently associated with all-cause mortality, falls, and overnight hospitalization. Our findings provide evidence that this approach may be a simple and feasible strategy to assess PR.
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Affiliation(s)
- Hui Zhang
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Meng Hao
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
- Fudan Zhangjiang Institute, Shanghai, China
| | - Yi Li
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Zixin Hu
- Artificial Intelligence Innovation and Incubation Institute, Fudan University, Shanghai, China
| | - Zuyun Liu
- School of Public Health and the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuai Jiang
- Department of Vascular Surgery, Shanghai Key Laboratory of Vascular Lesion Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Li Jin
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
| | - Xiaofeng Wang
- Human Phenome Institute, Zhangjiang Fudan International Innovation Centre, Fudan University, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Ye L, Tang X, Zhang H, Ge S, Yin L, Zhou Y, Chang J. Prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China: A cross-sectional Study. J Adv Nurs 2023; 79:3522-3534. [PMID: 37186471 DOI: 10.1111/jan.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
AIMS To examine the prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China. DESIGN A cross-sectional study. METHOD From January to July 2017, using the convenience sampling method, a total of 503 maintenance haemodialysis patients from six hospitals in Lianyungang, China, were recruited for this study. The participants' socio-demographic, lifestyle factors and health information were assessed using a general information questionnaire. Frailty was evaluated based on the Fried frailty phenotype. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population, including age, sex, living alone, employment, educational level, body mass index, per capita monthly household income, smoking status, exercise status, primary diagnosis, dialysis age, frequency of dialysis, vascular access, congestive heart failure, other cardiac diseases, cerebrovascular disease, peripheral blood diseases, pain, albumin level and haemoglobin level. RESULTS Among the 503 participants with an average age of 53.02 years (standard deviation 14.99), 178 had pre-frailty (35.3%) and were mostly young and middle-aged. The prevalence of pre-frailty among participants <60 years old was more than 40%. Regression analysis showed that lack of exercise, dialysis age ≤12 months, congestive heart failure and other cardiac diseases were positively associated with pre-frailty. Two hundred and eighteen participants were frail (43.3%), most of whom were aged ≥60. The prevalence of frailty in participants ≥60 was 71.4%. Regression analysis showed that advanced age, being female, obesity, low per capita monthly household income, lack of exercise, diabetes as the primary disease, dialysis age ≤12 months, congestive heart failure, other cardiac diseases, pain and low albumin level, were positively associated with frailty. In addition, more than half of the participants hardly exercised (64.6%), while lack of exercise was a risk factor for pre-frailty and frailty. A third of the participants had pain (33.4%), while pain was an independent risk factor for pre-frailty and frailty in these participants. CONCLUSION Pre-frailty and frailty are common in patients with maintenance haemodialysis. Most of the elderly maintenance haemodialysis patients are frail, and most of the young and middle-aged patients are pre-frail. Clinicians should actively screen the pre-frailty and frailty among patients with maintenance haemodialysis, especially those with dialysis age ≤12 months. Many factors affect pre-frailty and frailty in this population. Tailored intervention measures should be designed and implemented based on these factors, giving priority to exercise guidance and pain management for patients to help them prevent or reverse pre-frailty and frailty.
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Affiliation(s)
- Liqin Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Hailin Zhang
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Song Ge
- Department of Natural Sciences/Nursing, University of Houston-Downtown, Texas, Houston, USA
| | - Lixia Yin
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Ying Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
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Walston J, Varadhan R, Xue QL, Buta B, Sieber F, Oni J, Imus P, Crews DC, Artz A, Schrack J, Kalyani RR, Abadir P, Carlson M, Hladek M, DeMarco MM, Jones R, Johnson A, Shafi T, Newman AB, Bandeen-Roche K. A Study of Physical Resilience and Aging (SPRING): Conceptual framework, rationale, and study design. J Am Geriatr Soc 2023; 71:2393-2405. [PMID: 37386913 PMCID: PMC10608799 DOI: 10.1111/jgs.18483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023]
Abstract
Understanding the physiological basis of physical resilience to clinical stressors is crucial for the well-being of older adults. This article presents a novel framework to discover the biological underpinnings of physical resilience in older adults as part of the "Characterizing Resiliencies to Physical Stressors in Older Adults: A Dynamical Physiological Systems Approach" study, also known as The Study of Physical Resilience and Aging (SPRING). Physical resilience, defined as the capacity of a person to withstand clinical stressors and quickly recover or improve upon a baseline functional level, is examined in adults aged 55 years and older by studying the dynamics of stress response systems. The hypothesis is that well-regulated stress response systems promote physical resilience. The study employs dynamic stimulation tests to assess energy metabolism, the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, and the innate immune system. Baseline characteristics influencing resilience outcomes are identified through deep phenotyping of physical and cognitive function, as well as of biological, environmental, and psychosocial characteristics. SPRING aims to study participants undergoing knee replacement surgery (n = 100), bone and marrow transplantation (n = 100), or anticipating dialysis initiation (n = 60). Phenotypic and functional measures are collected pre-stressor and at multiple times after stressor for up to 12 months to examine resilience trajectories. By improving our understanding of physical resilience in older adults, SPRING has the potential to enhance resilient outcomes to major clinical stressors. The article provides an overview of the study's background, rationale, design, pilot phase, implementation, and implications for improving the health and well-being of older adults.
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Affiliation(s)
- Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
- Johns Hopkins School of Nursing
| | - Ravi Varadhan
- Department of Oncology, Division of Quantitative Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Brian Buta
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Frederick Sieber
- Dept of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center
| | - Julius Oni
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine
| | - Phil Imus
- Department of Oncology, Division of Hematologic Malignancy, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope
| | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine
| | - Peter Abadir
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Michelle Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | | | - Rick Jones
- Department of Oncology, Division of Hematologic Malignancy, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center
| | | | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Anne B. Newman
- Departments of Epidemiology and Medicine, University of Pittsburgh
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
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Lucas A, Rutledge J, Sloane R, Hall K, Green C, Pieper C, Colón-Emeric C, Hall R. Physical activity is a potential measure of physical resilience in older adults receiving hemodialysis. FRONTIERS IN NEPHROLOGY 2023; 2:1032468. [PMID: 37675031 PMCID: PMC10479669 DOI: 10.3389/fneph.2022.1032468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 09/08/2023]
Abstract
Background Physical resilience, or the ability to recover after a physical stressor, declines with aging. Efforts to preserve physical resilience in the older dialysis population are critically needed; however, validated, patient-centered measures that are sensitive to change are also needed. Our objective was to assess accelerometer-derived step count variability, or a measure of intra-individual variation in physical activity, as a potential measure of physical resilience among older adults receiving hemodialysis. Methods Community-dwelling ambulatory older adults receiving in-center hemodialysis were prospectively enrolled. Participants wore wrist accelerometers during daytime hours on both dialysis and non-dialysis days up to 14 days, and the feasibility of accelerometer use was assessed from wear time. We used accelerometer data to compute step counts in 4-hour blocks and step count variability. Physical function was assessed with the Short Physical Performance Battery (SPPB which includes gait speed test), grip strength, activities of daily living (ADLs) instruments, and life space mobility. We assessed interval fatigue (subjective rating from 0 to 10) on dialysis and non-dialysis days and self-reported recovery time. We assessed the correlations of step count variability with measures of physical function and step count and interval fatigue. Results Of 37 enrolled participants, 29 had sufficient accelerometer data for analyses. Among the 29 participants, mean (SD) age was 70.6(4.8) years, and 55% (n=16) were male and 72% (n=21) were Black race. Participants were largely sedentary with median (Q1-Q3) self-reported total kilocalories per week of 200 (36-552). Step count variability was positively correlated with measures of physical function: SPPB (r=0.50, p<0.05), gait speed (r=0.59, p<0.05), handgrip strength (r=0.71, p<0.05), Instrumental ADLs (r=0.44, p<0.05) and life space mobility (r=0.54, p<0.05).There was a weak inverse correlation between post-dialysis step counts (4-hour blocks after a dialysis session) and post-dialysis interval fatigue [r=-0.19 (n=102, p=0.06). Conclusions Physical activity assessment via accelerometer is feasible for older adults receiving hemodialysis. Step count variability correlated with physical function, so it may be a novel measure of physical resilience. Further studies are needed to validate this measure.
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Affiliation(s)
- Anika Lucas
- Durham Veterans Affairs Healthcare System, Renal Section, Durham, NC, United States
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, United States
| | - Jeanette Rutledge
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, United States
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Katherine Hall
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
- Durham Veterans Affairs Healthcare System, Geriatric Research Education and Clinical Center, Durham, NC, United States
| | - Ciara Green
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, United States
| | - Carl Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Cathleen Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
- Durham Veterans Affairs Healthcare System, Geriatric Research Education and Clinical Center, Durham, NC, United States
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, United States
| | - Rasheeda Hall
- Durham Veterans Affairs Healthcare System, Renal Section, Durham, NC, United States
- Department of Medicine, Division of Nephrology, Duke University, Durham, NC, United States
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
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Sheshadri A, Elia JR. Physical Resilience in Older Patients Incident to Hemodialysis: Can Following Trajectories Improve Our Ability to Intervene on Functional Decline? Kidney Int Rep 2022; 7:1927-1929. [PMID: 36090497 PMCID: PMC9459025 DOI: 10.1016/j.ekir.2022.07.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anoop Sheshadri
- University of California San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
- Kidney Health Research Collaborative, University of California, San Francisco, San Francisco, California, USA
- Correspondence: Anoop Sheshadri, Division of Nephrology, Department of Medicine, University of California, San Francisco San Francisco, California 94131-3204, USA.
| | - Jessica R. Elia
- University of California San Francisco, San Francisco, California, USA
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