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The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, and its association with renal outcomes remains unclear. In the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort, diet data were collected at baseline using food frequency questionnaires. Modified Poisson regression was used to examine the association of MIND diet with incident chronic kidney disease (CKD). In the REGARDS stroke case-cohort, 357 metabolites were measured in baseline plasma. Weighted linear regression was used to test associations between MIND diet and metabolites. Weighted logistic regression was used to test associations between MIND-associated metabolites and incident CKD. Mediation analyses were conducted to determine whether metabolites mediated the relationship between MIND diet and CKD. A higher MIND diet score was associated with a decreased risk of incident CKD (risk ratio 0.90, 95% CI (0.86–0.94); p = 2.03 × 10−7). Fifty-seven metabolites were associated with MIND diet (p < 3 × 10−4). Guanosine was found to mediate the relationship between MIND diet and incident CKD (odds ratio for indirect effects 0.93, 95% CI (0.88–0.97); p < 0.05). These findings suggest a role of the MIND diet in renal outcomes. [ABSTRACT FROM AUTHOR]

Background: Little is known about the content of communication in palliative care telehealth conversations in the dialysis population. Understanding the content and process of these conversations may lead to insights about how palliative care improves quality of life. Methods: We conducted a qualitative analysis of video recordings obtained during a pilot palliative teleconsultation program. We recruited patients receiving dialysis from five facilities affiliated with an academic medical center. Palliative care clinicians conducted teleconsultation using a wall-mounted screen with a camera mounted on a pole and positioned mid-screen in the line of sight to facilitate direct eye contact. Patients used an iPad that was attached to an IV pole positioned next to the dialysis chair. Conversations were coded using a preexisting framework of themes and content from the Serious Illness Conversation Guide (SICG) and revised Edmonton Symptom Assessment System—Renal. Results: We recruited 39 patients to undergo a telepalliative care consultation while receiving dialysis, 34 of whom completed the teleconsultation. Specialty palliative care clinicians (3 physicians and 1 nurse practitioner) conducted 35 visits with 34 patients. Median (interquartile range) duration of conversation was 42 (28–57) minutes. Most frequently discussed content included sources of strength (91%), critical abilities (88%), illness understanding (85%), fears and worries (85%), what family knows (85%), fatigue (77%), and pain (65%). Process features such as summarizing statements (85%) and making a recommendation (82%) were common, whereas connectional silence (56%), and emotion expression (21%) occurred less often. Conclusions: Unscripted palliative care conversations in outpatient dialysis units through telemedicine exhibited many domains recommended by the SICG, with less frequent discussion of symptoms. Emotion expression was uncommon for these conversations that occurred in an open setting. [ABSTRACT FROM AUTHOR]

Background: Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. Objective: To determine the feasibility and acceptability of telepalliative care in rural dialysis units. Methods: This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. Results: We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Discussion: Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117). [ABSTRACT FROM AUTHOR]

1. Participants will be able to define the concept of connectional silence (CS) and identify the criteria used to subcategorize CS in the context of telemedicine palliative care consultations. 2. Participants will understand the differences in telemedicine versus in person connectional silence (CS) and the impact on measurement of CS with human coding and computer algorithms. Despite its significance, research on connectional silence (CS) in telepalliative care is limited. This study addresses this gap. Combining human coding and machine learning, it explores CS prevalence and subtypes in telehealth, offering insights into enhancing empathetic care delivery. Connectional silence (CS) in palliative care conversations fosters comfort and trust and is linked to better quality of life and decision-making. COVID-19 highlighted the role of telehealth however it is unclear if CS is present or different in telehealth compared to in-person communication. We sought to determine the prevalence of CS in telepalliative care using dual human and computer approaches. We studied participants from the "Telemedicine facilitated palliative care consultations in rural dialysis study," who were recruited between 2018-20 from five dialysis units. A human coder identified silence defined as pauses of ≥ 2 seconds with no utterances from audio files. Pauses were double-coded as CS and sub-categorized as invitational, emotional, or compassionate. Next, CS were identified using an established computer algorithm based on convolutional neural networks and random forest machine learning methods. 39 participants (90% non-Hispanic White, 56% male) were recruited and 34 participants completed a telepalliative care consultation recorded via Zoom. Intra-rater reliability for CS was 93.5%. Human coding identified 666 pauses of ≥ 2 seconds and computer coding identified 360 pauses of ≥ 2 seconds, with 151 pauses identified by both methods. Among human-identified pauses, 57 (8.6%) were CS. There were 43 (75.4%) invitational CS and 10 (17.5%) emotional CS. CS was identified using human and established computer algorithms during telehealth palliative care consultations with patients receiving dialysis. The prevalence of CS in these teleconsults was similar to a reported prevalence for in-person palliative care. Invitational CS was more common in televideos than in prior work, which may be due to the conversational and technical aspects of telehealth. We confirm the presence of CS in telepalliative care conversations using human and computer coding approaches, which supports the use of telehealth for palliative care delivery in rural settings. [ABSTRACT FROM AUTHOR]

The article "Perspectives from Rising Stars at the R13 NIA/AGS Conference on Resilience Biomarkers" discusses a conference that brought together senior and junior investigators to explore resilience biomarkers in older adults. The conference focused on defining resilience, discussing the biology of resilience, factors influencing resilience biology, and biomarker testing. The group highlighted key features of resilience biomarkers and recommended categorizing them based on stressors. While no universal biomarker panel was identified, recommendations were made for different types of resilience biomarkers, including circulating, physiologic, psychosocial, and imaging biomarkers. The group emphasized the importance of measuring biomarkers across different scales and dimensions to enhance understanding of resilience. [Extracted from the article]

Abstract Chronic kidney disease (CKD) affects 30 million Americans and is associated with approximately a two-fold increased risk of venous thromboembolism (VTE). There is a graded increased risk of VTE across declining kidney function, as measured by estimated glomerular filtration rate (eGFR) and albuminuria. When patients with end-stage kidney disease (ESKD) experience VTE they are more likely than the general population to be hospitalized and they have a higher mortality. The incidence and consequences of VTE may also differ depending on the cause of kidney disease. In addition, kidney transplant patients with VTE are at a greater risk for death and graft loss than transplant patients without VTE. The reasons that patients with CKD are at increased risk of VTE are not well understood, but recent data suggest that factor VIII is a mediator. Factor VIII is an essential cofactor in the coagulation cascade and a strong risk factor for VTE in general. It is inversely correlated with eGFR and prospective studies demonstrate that factor VIII activity predicts incident CKD and rapid eGFR decline. The etiology of CKD may also influence factor VIII levels. This review summarizes the epidemiology VTE in CKD and reviews the biochemistry of factor VIII and determinants of its levels, including von Willebrand factor and ABO blood group. We explore mechanisms by which the complications of CKD might give rise to higher factor VIII and suggests future research directions to understand how factor VIII and CKD are linked. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress and inflammation are proposed mechanisms of nonspecific kidney injury and progressive kidney failure. Higher dietary oxidative balance scores (OBS) are associated with lower prevalence of chronic kidney disease (CKD). Methods: We investigated the association between OBS and biomarkers of inflammation using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Nutrient estimates from the Block Food Frequency Questionnaires were used to define tertiles of 11 pro- and antioxidant factors. Points for each OBS component were summed, with a higher score indicating predominance of antioxidant exposures. Multivariable linear regression models were used to estimate the association between OBS and biomarkers of inflammation (interleukin-6 [IL-6], interleukin-8 [IL-8], interleukin-10 [IL-10], fibrinogen, C-reactive protein [CRP], white blood cell count, and cystatin C). An interaction term was included to determine if associations between OBS and inflammatory markers differed between individuals with and without CKD. Results: Of 682 participants, 22.4% had CKD. In adjusted models, OBS was associated with CRP and IL-6. For every 5-unit increase in OBS, the CRP concentration was -15.3% lower (95% CI: -25.6, -3.6). The association of OBS with IL-6 differed by CKD status; for every 5-unit increase in OBS, IL-6 was -10.7% lower (95% CI: -16.3, -4.7) among those without CKD, but there was no association among those with CKD (p = 0.03). Conclusion: This study suggests that a higher OBS is associated with more favorable levels of IL-6 and CRP, and that the association of OBS and IL-6 may be modified by CKD status. [ABSTRACT FROM AUTHOR]

The article focuses on kidney failure, or end-stage kidney disease (ESKD), is a life-altering condition, with a one-year mortality rate and the incidence is expected to rise in 2030, compared with 2015 levels. Topics include the patients with kidney failure experience a high burden of symptoms that are often unaddressed during their dialysis treatments, and the COVID-19 pandemic has presented novel challenges in administering nonpharmacological pain.

Background: The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). Methods: MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). Results: Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. Discussion: VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. Trial Registration: Prospero CRD42013004338 [ABSTRACT FROM AUTHOR]

The article discusses the increase of kidney dialysis patients with lower functional status and greater comorbidity. Topics include the mortality rate adjusted for patients in dialysis, the implemented strategy of palliative care to patients brought in an in-center hemodialysis unit and the benefits in maintenance dialysis.

Introduction: Vasomotor symptoms (VMS) are common menopausal symptoms and the timing of these symptoms, specifically onset of late VMS, has recently been linked with cardiovascular risk factors. Chronic kidney disease (CKD) affects 13% of all women in the US and carries high risk for cardiovascular disease (CVD). The association between CKD and VMS has not been studied. Hypothesis: We hypothesized that the timing of VMS would differ between women with CKD compared to women without CKD. We also hypothesized that CKD would modify the effect of VMS on all-cause mortality, coronary heart disease and stroke. Methods: We studied the Women's Health Initiative (WHI) biomarker cohort, which is comprised of all black and Hispanic participants in the WHI observation study and clinical trials plus a subset of white WHI participants such that the biomarker cohort reflects the age distribution of the HT population. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73m and VMS was defined as self-report of hot flushes and night sweats. We used polytomous logistic regression to determine the cross-sectional associations (unadjusted, demographics-adjusted and multivariable-adjusted between CKD and reported VMS categories (none, early, late, persistent). We used Cox proportional hazards models with an interaction term to determine whether the association between late VMS and all-cause mortality or incident CVD was modified by CKD. Results: Among the 18,024 WHI participants, 1281 women (5.86%) had CKD. VMS were less common in women with CKD versus without CKD (37.6% vs 45.8%, p<0.001). Prevalent CKD was associated with an OR of 0.85 (95% CI: 0.72, 1.00) for early VMS, OR 0.80 (95% CI: 0.66, 0.97) for late VMS, and OR 0.59 (95% CI: 0.50, 0.70) for persistent VMS, as compared to having no VMS. The overall association of CKD was not significant after adjusting for potential confounders (p=0.17). CKD was associated with increased risk for mortality (HR 1.72, 95% CI: 1.52, 1.95), coronary heart disease (HR 1.60, 95% CI: 1.33, 1.92) and stroke (HR 1.49, 95% CI: 1.18, 1.87). Late VMS were associated with increased all-cause mortality (HR 1.16, 95%CI 1.04, 1.30) but not significantly associated with coronary heart disease or stroke. No significant interactions were found between late VMS and CKD on any of the endpoints studied. Conclusions: In this multiethnic cohort, VMS were less common in women with CKD and CKD did not appear to modify the association between VMS and either incident CVD or total mortality. [ABSTRACT FROM AUTHOR]

Context: Outcomes after cardiopulmonary resuscitation (CPR) remain poor. We have spent 10 years investigating an "informed assent" (IA) approach to discussing CPR with chronically ill patients/families. IA is a discussion framework whereby patients extremely unlikely to benefit from CPR are informed that unless they disagree, CPR will not be performed because it will not help achieve their goals, thus removing the burden of decision-making from the patient/family, while they retain an opportunity to disagree.Objectives: Determine the acceptability and efficacy of IA discussions about CPR with older chronically ill patients/families.Methods: This multi-site research occurred in three stages. Stage I determined acceptability of the intervention through focus groups of patients with advanced COPD or malignancy, family members, and physicians. Stage II was an ambulatory pilot randomized controlled trial (RCT) of the IA discussion. Stage III is an ongoing phase 2 RCT of IA versus attention control in in patients with advanced chronic illness.Results: Our qualitative work found the IA approach was acceptable to most patients, families, and physicians. The pilot RCT demonstrated feasibility and showed an increase in participants in the intervention group changing from "full code" to "do not resuscitate" within two weeks after the intervention. However, Stages I and II found that IA is best suited to inpatients. Our phase 2 RCT in older hospitalized seriously ill patients is ongoing; results are pending.Conclusions: IA is a feasible and reasonable approach to CPR discussions in selected patient populations. [ABSTRACT FROM AUTHOR]

Background: Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks., Study Design: Prospective cohort study., Setting & Participants: 30,239 black and white adults 45 years or older enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study 2003 to 2007., Predictors: Estimated glomerular filtration rate (eGFR) using the combined creatinine-cystatin C (eGFR cr-cys ) equation and urinary albumin-creatinine ratio (ACR)., Outcomes: The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event., Results: During 4.6 years of follow-up, 239 incident VTE events occurred over 124,624 person-years. Cause-specific HRs of VTE were calculated using proportional hazards regression adjusted for age, sex, race, region of residence, and body mass index. Adjusted VTE HRs for eGFR cr-cys of 60 to <90, 45 to <60, and <45 versus ≥90mL/min/1.73m 2 were 1.28 (95% CI, 0.94-1.76), 1.30 (95% CI, 0.77-2.18), and 2.13 (95% CI, 1.21-3.76). Adjusted VTE HRs for ACR of 10 to <30, 30 to <300, and ≥300 versus <10mg/g were 1.14 (95% CI, 0.84-1.56), 1.15 (95% CI, 0.79-1.69), and 0.64 (95% CI, 0.25-1.62). Associations were similar for provoked and unprovoked VTE., Limitations: Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power., Conclusions: There was an independent association of low eGFR (<45 vs ≥90mL/min/1.73m 2 ) with VTE risk, but no association of ACR and VTE., (Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: This study aims to determine whether menopausal symptoms differed between women with chronic kidney disease (CKD) and women without CKD, and whether CKD modified associations of late vasomotor symptoms (VMS) with mortality and/or cardiovascular events., Methods: CKD, defined as estimated glomerular filtration rate lower than 60 mL/minute/1.73 m (using the Chronic Kidney Disease Epidemiology Collaboration equation), was determined in 17,891 postmenopausal women, aged 50 to 79 years at baseline, in the multiethnic Women's Health Initiative cohort. Primary outcomes were presence, severity, and timing/duration of VMS (self-reported hot flashes and night sweats) at baseline. We used polytomous logistic regression to test for associations among CKD and four VMS categories (no VMS; early VMS-present before menopause but not at study baseline; late VMS-present only at study baseline; persistent VMS-present before menopause and study baseline) and Cox regression to determine whether CKD modified associations between late VMS and mortality or cardiovascular events., Results: Women with CKD (1,017 of 17,891; mean estimated glomerular filtration rate, 50.7 mL/min/1.73 m) were more likely to have had menopause before age 45 years (26% vs 23%, P = 0.02) but were less likely to experience VMS (38% vs 46%, P < 0.001) than women without CKD. Women with CKD were not more likely than women without CKD to experience late VMS. Late VMS (hazard ratio, 1.16; 95% CI, 1.04-1.29) and CKD (hazard ratio, 1.74; 95% CI, 1.54-1.97) were each independently associated with increased risk for mortality, but CKD did not modify the association of late VMS with mortality (Pinteraction = 0.53), coronary heart disease (Pinteraction = 0.12), or stroke (Pinteraction = 0.68)., Conclusions: Women with mild CKD experience earlier menopause and fewer VMS than women without CKD.