Mariana Markell - Academia.edu (original) (raw)
Papers by Mariana Markell
Journal of Investigative Medicine, 2004
Current Developments in Nutrition
Objectives Understanding the obstacles to adoption of PBE by inner-city patients is essential to ... more Objectives Understanding the obstacles to adoption of PBE by inner-city patients is essential to provide effective nutrition counseling for management of chronic health conditions that may be improved by this dietary pattern. Methods A telephone survey was conducted in a random convenience sample of patients from FM (18) and CKD (13) clinics. Questionnaires regarding familiarity with PBE and the Multidimensional Health Locus Questionnaire (MHLC) were administered. Diet analysis was performed by 24-hr dietary recall using ASA24 software. Entries reporting <800 kcal were excluded as possibly incomplete. An PBE index (PB-I) was calculated by averaging the difference in grams cholesterol (only in animal products) and grams fiber (only in plant sources) over total kcal. Results Mean age was 63.13 ± 10.4 yrs. 10 were male (32%) and 21 female (68%). 22 were Black (71%), 3 Hispanic (10%), 1 white (3%), 4 other (17%). There was no difference between FM and CKD for nutrition parameters, in...
Current Developments in Nutrition
Objectives Poor nutritional literacy may influence understanding and adherence to dietary guideli... more Objectives Poor nutritional literacy may influence understanding and adherence to dietary guidelines. We examined nutritional literacy and adherence to dietary guidelines in inner-city dialysis patients. Methods A random sample of 34 dialysis pts was interviewed regarding knowledge about dietary guidelines and 24-hr food recall was recorded and analyzed using ASA-24. Nutritional literacy was assessed using the food label questionnaire. Results Mean age was 56 ± 17, 58% (20) male, 88% (29) identified as Black, time on dialysis 64.1 ± 17.3 mos. Mean PO4 intake was 968.2 ± 111.9 mg, sodium 2487 ± 240 mg, potassium 1983 ± 222 mg. There was no association between age, sex, income or time on dialysis and adherence to dietary guidelines. All pts received monthly nutrition counseling. 18/24 (75%) pts said they did not know daily dietary sodium allowance, none answered correctly. 2/6 (33%) who stated they knew consumed <2300 mg while 8/18 (44%) who didn't know consumed less. Higher so...
Current Developments in Nutrition
Objectives Higher % body fat has been associated with increased risk for multiple diseases especi... more Objectives Higher % body fat has been associated with increased risk for multiple diseases especially if it has a visceral distribution. We studied body fat patterns in a population of inner-city KTRs at risk for food scarcity to explore access to nutrition and its relationship to % body fat. Methods A random sample of 16 stable long-term pts from kidney transplant clinic were studied using the InBody S10 body composition analyzer at a regularly scheduled appointment. Pts were seated and electrodes were attached to the middle fingers, thumbs and below each ankle. Food scarcity was assessed by a standardized survey. Results 63% (10) pts had body fat >25% (HIFAT). They did not differ from pts with body fat <25% (6 pts, LOFAT) in time since transplant (mean 10.6 ± 4.0 yrs), race, education, or annual income. 12 (75%) pts identified as black, 2 (12.5%) white and 2 (12.5%) other. The majority (56.3%) had an annual income < $20 k. HIFAT pts had higher visceral fat (14.0 ± 1.3 vs ...
Current Developments in Nutrition, 2020
Objectives We evaluated dietary intake in patients with kidney disease with and without diabetes ... more Objectives We evaluated dietary intake in patients with kidney disease with and without diabetes in inner-city Brooklyn clinics. Methods A face-to-face survey was conducted in a random convenience sample of pts from CKD (23) and transplant (45) clinics. Diet was studied by 24-hour recall using ASA24 software. Healthy Eating Index was calculated using the HEI-15 score and the DASH index as standard. Between group comparison was by t-test unless noted. Results There were 37 males (54%) and 31 (46%) females, 56 (82%) Black, 24/62 (24%) received SNAP benefits. 24 (53%) transplant (TXP) and 13 (57%) CKD pts had diabetes (DIAB). By Chi square, DIAB were more likely to make < $20 K/yr (58% vs 23%, P = 0.015) and be unemployed (89% vs 61%, P = 0.018). DIAB were older (61.8 ± 1.6 vs 50.3 ± 2.25 yrs, P < 0.0001). Creatinine was 1.86 ± 1.09 mg/dl. HbA1c was 11.1 ± 3.1, time with diabetes 206.03 ± 26.9 months. Blood pressure, BMI, albumin, potassium and total cholesterol did not differ bu...
Current Developments in Nutrition, 2019
Objectives We examined factors associated with adherence to 2.3 g/d sodium intake in a population... more Objectives We examined factors associated with adherence to 2.3 g/d sodium intake in a population of inner-City patients from specialty clinics where sodium restriction is advised. Methods A random sample of 109 patients from an inner-city CKD (37), dialysis (23), medicine/diabetes (18) and transplant clinic (31) were studied. Dietary intake was assessed by 24-hour food recall, analyzed using ASA24 software and used to calculate Healthy Eating Index (HEI). Nutritional literacy was assessed via the Newest Vital Signs toolkit. Depression and anxiety were assessed using PHQ-9 and PSS scales. Results There were 41 (38%) men and 67 (62%) women with 89 black, 5 white, 3 Hispanic and 14 other. 71 (65%) pts were foreign born (time in the US 35.9 ± 15.3 yrs). 43/81 (53%) pts made <$20 K/yr. Mean BMI was 29.2 ± 6.4. Mean sodium intake was 2.53 ± 0.99 g/d (range 0.95 to 6.67 g). 14 pts (14%) restricted sodium to <1.5 g/d. 45 (41%) pts ate 2.3 g or less sodium/day (LoNa). LoNa pts were ol...
Current Opinion in Organ Transplantation, 2018
Purpose of review Complementary and integrative medicine (CIM) use is widely prevalent in kidney ... more Purpose of review Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients. Recent findings The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. There is a knowledge gap regarding CIM modalities among healthcare professionals that may contribute to reluctance to discuss CIM use with patients. Patients often do not spontaneously disclose its use, and those that use it may be more likely to be nonadherent to allopathic therapies. Herbal supplements may be nephrotoxic or interact with pharmaceutical agents, including calcineurin inhibitors. More data are needed to assess the potential benefits of other modalities of CIM, including yoga, Tai Chi or meditation, as these modalities have been beneficial for people with diabetes or hypertension, both of which are common in the posttransplant period. Summary Despite a high prevalence of CIM use in kidney transplant recipients, data are limited regarding risks and benefits. Education of healthcare providers who care for kidney transplant recipients should be encouraged. Intervention studies should be designed to investigate the CIM modalities, including yoga, meditation and Tai Chi that have been shown to be beneficial in other chronic diseases.
Nephrology and Urology in the Aged Patient, 1993
The number of elderly patients being treated for endstage renal disease (ESRD) in the United Stat... more The number of elderly patients being treated for endstage renal disease (ESRD) in the United States has risen progressively over the past 10 years. According to the 1991 US Renal Data Systems annual report, 78,478 patients over the age of 55 were receiving ESRD treatment at the end of 1989; 45,790 of these patients were over the age of 65 [1]. Renal transplantation has become the replacement therapy of choice for the majority of patients with ESRD [2]. An increasing number of older patients are asking for the transplant workup and an increasing number of elderly patients are receiving kidney transplants (Fig. 1). Despite this, the rate of transplantation among the elderly remains much lower than for the younger population, even for those at the lower end of the age range. Only 20.7% (3167) ESRD patients between the ages of 55–59 had functioning kidney transplants at the end of 1989, compared with 40% (5708) of all patients between the ages of 40 and 44 years and 46.5% (4265) of all patients between the ages of 30 and 34 [1]. For patients over the age of 60, the rate drops even lower; only 5.7% (984) of patients between the ages of 65 and 69 had a kidney transplant as their ESRD therapy.
Advances in Renal Replacement Therapy, 2001
Post-transplant diabetes mellitus (PTDM) is one of the feared complications of immunosuppressive ... more Post-transplant diabetes mellitus (PTDM) is one of the feared complications of immunosuppressive therapy. Despite advances, including the introduction of the steroid-sparing calcineurin inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater than 10% to 30%, especially in minority populations. PTDM increases the subsequent risk of both graft loss and patient death, and predisposes patients to all complications of diabetes, including retinopathy and neuropathy. Patients should be monitored closely, especially during the first 3 months post-transplant, and treated aggressively, should glucose intolerance be detected. Minimization of immunosuppression dose, diet, oral hypoglycemic agents, and insulin have all been used in the treatment of PTDM, however, the insulin-sensitizing agents have not been studied. It is hoped that newer immunosuppressive regimens and, ultimately, the ability to achieve tolerance will eventually solve the problem of PTDM.
Current Developments in Nutrition, 2020
Objectives We compared beliefs about plant-based eating and dietary intake in patients attending ... more Objectives We compared beliefs about plant-based eating and dietary intake in patients attending inner-City CKD and Family Medicine (FM) clinics. Methods A face-to-face survey was conducted in a random convenience sample of pts in CKD (23) and FM clinics (22). Patients were asked to answer 5 multiple choice questions assessing their beliefs regarding difficulty in finding plant-based foods in restaurants, affordability, ability to get proteins and vitamins, and ability to find good tasting recipes. A mean score was calculated. Lower score indicates more difficulty (PBE-score). Diet analysis was based on 24hr recall and analyzed using ASA-24 software. Comparisons are by t-test unless noted. Results Mean age was 54.3 ± 2.5 yrs. There were 16 (35.6%) males and 22 (62.2%) females with 40 black (89%). 36 (80%) had not completed college. 23 (51%) had an income < $20 K. 16 (35%) were employed. 20 (44%) had diabetes. 22 (49%) received SNAP benefits. Mean BMI was 30.4 ± 1.6 with 41% > ...
Current Developments in Nutrition
Objectives This case illustrates the importance of screening for food insecurity during outpatien... more Objectives This case illustrates the importance of screening for food insecurity during outpatient visits. According to the USDA Economic Research Service, food insecurity affected approximately 38.3 million people in the United States during 2020. Health outcomes studies have shown that food insecurity is associated with increased rates of mental health problems and poor outcomes on health exams in non-senior adults, but only a minority of healthcare professionals regularly screen for food insecurity in their patients. Methods A 53-year-old woman with no significant past medical history presented to a student-run free clinic for evaluation of shoulder. The patient was unemployed, had lost weight unintentionally, and was a vegetarian with meals that consisted of vegetables, beans, and nuts. She mentioned that she fasted multiple times a month, describing it as “detoxing,” but also alluding to financial reasons for her dietary choices. The team proceeded to ask more direct questions ...
Current Developments in Nutrition
Objectives Pts who receive hemodialysis require strict dietary restrictions and have encountered ... more Objectives Pts who receive hemodialysis require strict dietary restrictions and have encountered increased difficulties due to COVID-19. We examined food purchasing patterns and dietary intake during the pandemic in a population of inner-city dialysis patients. Methods A random sample of 32 dialysis patients were surveyed regarding general food purchasing habits and changes due to COVID-19. Dietary intake was assessed using 24-hour food recall and analyzed using ASA-24. Results Mean age was 56.8 ± 18.2 years. Mean dialysis time was 88.0 ± 104.0 months. There were 20 (62.5%) male, 29 (90.6%) identified as black, 18 (56%) had a high school diploma or less, and 14 (44%) completed some college or more. Mean calories was 1438.0 ± 650.5 kcal, protein was 70.2 ± 39.7 g, fat was 52.5 ± 29.6 g, carbohydrate was 173.3 ± 92.5 g, and phosphorus was 986.0 ± 537.7 mg. 11 pts purchased breakfast rather than making it at home at least once a week (PUR). Calories (1686.2 ± 674.0 vs. 1031.8 ± 346.7, ...
Current Developments in Nutrition
Objectives The COVID-19 pandemic created nutritional stressors in indigent patients, especially t... more Objectives The COVID-19 pandemic created nutritional stressors in indigent patients, especially those with diets prescribed for chronic disease. We studied use of SNAP benefits and how food purchasing behavior was affected in a cohort of inner-city dialysis patients during the past year. Methods 33 dialysis patients were surveyed face to face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over 12 months prior to the summer of 2021. The survey also assessed patient attitudes and fears relating to food purchasing due to COVID-19. Results Mean age was 57.1 ± 17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under 20,000with7020,000 with 70% less than 20,000with7040,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p = 0.019). Age correlated inversely with feeling safe eating at a restaurant indoors (r = −0.47, p = 0.008), or outdoors (r = −0.58, p = <...
Current Developments in Nutrition
Objectives PBE may result in healthier eating in both patients on hemodialysis and those with oth... more Objectives PBE may result in healthier eating in both patients on hemodialysis and those with other advanced kidney diseases, with increased phosphorous and potassium allowances as well as lower acid load. Understanding interest in and beliefs regarding plant based eating (PBE) in an underserved inner-city pt population with kidney disease may help tailor healthier eating plans based on PBE. Methods A random sample of 33 dialysis and 22 kidney transplant pts in an inner-city environment were surveyed regarding beliefs about PBE and dietary intake by 24-hour recall using the ASA24 database. Results did not differ between populations so they were analyzed together. Not all pts completed all questions. Results Mean age was 55.3 ± 2.1 yrs, 54% male (30); 88% (49) identified as Black, 36% US-born (20); 77% (30) reported annual income <$40K, 64% (35) did not finish college. 8/28 (29%) reported having tried PBE, and 22/39 (57%) were interested. 52% of patients (29) reported not having b...
Circulation: Cardiovascular Quality and Outcomes, 2011
Nonadherence is a problem in pts with HF. Negative belief about the specific necessity of medicat... more Nonadherence is a problem in pts with HF. Negative belief about the specific necessity of medications (SNmed) correlates with nonadherence in the general population. Studies have suggested that medication beliefs are culture specific. Many minority pts have negative med beliefs and distrust the healthcare system. This has been correlated with lower levels of adherence. High levels of SNmed have been demonstrated in asthmatics and correlate with adherence, which may be attributed to relationship of med use and symptom relief. 41 pts with HF whose symptom relief might also be related to med usage were compared with 79 kidney transplant recipients (KTR), whose transplant meds do not directly affect their symptoms, using the Beliefs in Medicine Questionnaire, which examines beliefs regarding necessity, overuse and general harm of prescribed meds using a 5 point Likert scale. The possible range for SNmed is 5-25, higher scores indicate more positive beliefs. There were 108/120 (90%) Blac...
Current Developments in Nutrition, 2021
Objectives We examined the impact of the COVID19 pandemic on dietary intake in an inner-city popu... more Objectives We examined the impact of the COVID19 pandemic on dietary intake in an inner-city population of CKD and KTx patients. Methods Dietary intake was assessed using 24-hour recall in a random sample of patients from CKD and Transplant clinics in 2019 (48) and in 2020 (30). Dietary assessments were conducted in person in 2019 and by phone in 2020. Diets were analyzed using ASA-24 software. Entries with less than 1,100 kcal were excluded from analysis. There was no difference in patterns between the two clinics so they were analyzed together. Statistical analysis was by t-test or Chi-square as appropriate. Results The 2019 cohort and the 2020 cohort were similar for age (55.9 ± 12.5 vs 60.0 ± 11.7, P = 0.148), gender (60.4% vs 43.3% male, P = 0.141), race (81.3% vs 69.2% Black, P = 0.241), and education (75% vs 80.8% with less than a college degree, P = 0.573). The 2020 patients consumed fewer total calories (1513.16 ± 350.82 vs 1731.02 ± 573.07 kcal, P = 0.041) compared to 2019...
Journal of the American Society of Nephrology, 1997
Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hy... more Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hyperparathyroidism may persist or develop after renal transplantation and eventually require parathyroidectomy. Avid calcium retention by demineralized bones (hungry bone syndrome) is well-recognized after parathyroidectomy and usually resolves after a few weeks. This report documents the case of a renal transplant recipient with persistent hyperparathyroidism who developed a pathological fracture of the pelvis and required parathyroidectomy 1 year after transplant and then manifested severe and prolonged hungry bone syndrome lasting for more than 20 months postoperatively. The clinical features and treatment of hyperparathyroidism in renal transplant recipients are discussed, as are diagnosis, pathogenesis, and management of hungry bone syndrome. Recognition of renal transplant recipients at greater risk for severe hungry bone syndrome should permit earlier and more aggressive management...
Journal of Investigative Medicine, 2004
Current Developments in Nutrition
Objectives Understanding the obstacles to adoption of PBE by inner-city patients is essential to ... more Objectives Understanding the obstacles to adoption of PBE by inner-city patients is essential to provide effective nutrition counseling for management of chronic health conditions that may be improved by this dietary pattern. Methods A telephone survey was conducted in a random convenience sample of patients from FM (18) and CKD (13) clinics. Questionnaires regarding familiarity with PBE and the Multidimensional Health Locus Questionnaire (MHLC) were administered. Diet analysis was performed by 24-hr dietary recall using ASA24 software. Entries reporting <800 kcal were excluded as possibly incomplete. An PBE index (PB-I) was calculated by averaging the difference in grams cholesterol (only in animal products) and grams fiber (only in plant sources) over total kcal. Results Mean age was 63.13 ± 10.4 yrs. 10 were male (32%) and 21 female (68%). 22 were Black (71%), 3 Hispanic (10%), 1 white (3%), 4 other (17%). There was no difference between FM and CKD for nutrition parameters, in...
Current Developments in Nutrition
Objectives Poor nutritional literacy may influence understanding and adherence to dietary guideli... more Objectives Poor nutritional literacy may influence understanding and adherence to dietary guidelines. We examined nutritional literacy and adherence to dietary guidelines in inner-city dialysis patients. Methods A random sample of 34 dialysis pts was interviewed regarding knowledge about dietary guidelines and 24-hr food recall was recorded and analyzed using ASA-24. Nutritional literacy was assessed using the food label questionnaire. Results Mean age was 56 ± 17, 58% (20) male, 88% (29) identified as Black, time on dialysis 64.1 ± 17.3 mos. Mean PO4 intake was 968.2 ± 111.9 mg, sodium 2487 ± 240 mg, potassium 1983 ± 222 mg. There was no association between age, sex, income or time on dialysis and adherence to dietary guidelines. All pts received monthly nutrition counseling. 18/24 (75%) pts said they did not know daily dietary sodium allowance, none answered correctly. 2/6 (33%) who stated they knew consumed <2300 mg while 8/18 (44%) who didn't know consumed less. Higher so...
Current Developments in Nutrition
Objectives Higher % body fat has been associated with increased risk for multiple diseases especi... more Objectives Higher % body fat has been associated with increased risk for multiple diseases especially if it has a visceral distribution. We studied body fat patterns in a population of inner-city KTRs at risk for food scarcity to explore access to nutrition and its relationship to % body fat. Methods A random sample of 16 stable long-term pts from kidney transplant clinic were studied using the InBody S10 body composition analyzer at a regularly scheduled appointment. Pts were seated and electrodes were attached to the middle fingers, thumbs and below each ankle. Food scarcity was assessed by a standardized survey. Results 63% (10) pts had body fat >25% (HIFAT). They did not differ from pts with body fat <25% (6 pts, LOFAT) in time since transplant (mean 10.6 ± 4.0 yrs), race, education, or annual income. 12 (75%) pts identified as black, 2 (12.5%) white and 2 (12.5%) other. The majority (56.3%) had an annual income < $20 k. HIFAT pts had higher visceral fat (14.0 ± 1.3 vs ...
Current Developments in Nutrition, 2020
Objectives We evaluated dietary intake in patients with kidney disease with and without diabetes ... more Objectives We evaluated dietary intake in patients with kidney disease with and without diabetes in inner-city Brooklyn clinics. Methods A face-to-face survey was conducted in a random convenience sample of pts from CKD (23) and transplant (45) clinics. Diet was studied by 24-hour recall using ASA24 software. Healthy Eating Index was calculated using the HEI-15 score and the DASH index as standard. Between group comparison was by t-test unless noted. Results There were 37 males (54%) and 31 (46%) females, 56 (82%) Black, 24/62 (24%) received SNAP benefits. 24 (53%) transplant (TXP) and 13 (57%) CKD pts had diabetes (DIAB). By Chi square, DIAB were more likely to make < $20 K/yr (58% vs 23%, P = 0.015) and be unemployed (89% vs 61%, P = 0.018). DIAB were older (61.8 ± 1.6 vs 50.3 ± 2.25 yrs, P < 0.0001). Creatinine was 1.86 ± 1.09 mg/dl. HbA1c was 11.1 ± 3.1, time with diabetes 206.03 ± 26.9 months. Blood pressure, BMI, albumin, potassium and total cholesterol did not differ bu...
Current Developments in Nutrition, 2019
Objectives We examined factors associated with adherence to 2.3 g/d sodium intake in a population... more Objectives We examined factors associated with adherence to 2.3 g/d sodium intake in a population of inner-City patients from specialty clinics where sodium restriction is advised. Methods A random sample of 109 patients from an inner-city CKD (37), dialysis (23), medicine/diabetes (18) and transplant clinic (31) were studied. Dietary intake was assessed by 24-hour food recall, analyzed using ASA24 software and used to calculate Healthy Eating Index (HEI). Nutritional literacy was assessed via the Newest Vital Signs toolkit. Depression and anxiety were assessed using PHQ-9 and PSS scales. Results There were 41 (38%) men and 67 (62%) women with 89 black, 5 white, 3 Hispanic and 14 other. 71 (65%) pts were foreign born (time in the US 35.9 ± 15.3 yrs). 43/81 (53%) pts made <$20 K/yr. Mean BMI was 29.2 ± 6.4. Mean sodium intake was 2.53 ± 0.99 g/d (range 0.95 to 6.67 g). 14 pts (14%) restricted sodium to <1.5 g/d. 45 (41%) pts ate 2.3 g or less sodium/day (LoNa). LoNa pts were ol...
Current Opinion in Organ Transplantation, 2018
Purpose of review Complementary and integrative medicine (CIM) use is widely prevalent in kidney ... more Purpose of review Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients. Recent findings The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. There is a knowledge gap regarding CIM modalities among healthcare professionals that may contribute to reluctance to discuss CIM use with patients. Patients often do not spontaneously disclose its use, and those that use it may be more likely to be nonadherent to allopathic therapies. Herbal supplements may be nephrotoxic or interact with pharmaceutical agents, including calcineurin inhibitors. More data are needed to assess the potential benefits of other modalities of CIM, including yoga, Tai Chi or meditation, as these modalities have been beneficial for people with diabetes or hypertension, both of which are common in the posttransplant period. Summary Despite a high prevalence of CIM use in kidney transplant recipients, data are limited regarding risks and benefits. Education of healthcare providers who care for kidney transplant recipients should be encouraged. Intervention studies should be designed to investigate the CIM modalities, including yoga, meditation and Tai Chi that have been shown to be beneficial in other chronic diseases.
Nephrology and Urology in the Aged Patient, 1993
The number of elderly patients being treated for endstage renal disease (ESRD) in the United Stat... more The number of elderly patients being treated for endstage renal disease (ESRD) in the United States has risen progressively over the past 10 years. According to the 1991 US Renal Data Systems annual report, 78,478 patients over the age of 55 were receiving ESRD treatment at the end of 1989; 45,790 of these patients were over the age of 65 [1]. Renal transplantation has become the replacement therapy of choice for the majority of patients with ESRD [2]. An increasing number of older patients are asking for the transplant workup and an increasing number of elderly patients are receiving kidney transplants (Fig. 1). Despite this, the rate of transplantation among the elderly remains much lower than for the younger population, even for those at the lower end of the age range. Only 20.7% (3167) ESRD patients between the ages of 55–59 had functioning kidney transplants at the end of 1989, compared with 40% (5708) of all patients between the ages of 40 and 44 years and 46.5% (4265) of all patients between the ages of 30 and 34 [1]. For patients over the age of 60, the rate drops even lower; only 5.7% (984) of patients between the ages of 65 and 69 had a kidney transplant as their ESRD therapy.
Advances in Renal Replacement Therapy, 2001
Post-transplant diabetes mellitus (PTDM) is one of the feared complications of immunosuppressive ... more Post-transplant diabetes mellitus (PTDM) is one of the feared complications of immunosuppressive therapy. Despite advances, including the introduction of the steroid-sparing calcineurin inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater than 10% to 30%, especially in minority populations. PTDM increases the subsequent risk of both graft loss and patient death, and predisposes patients to all complications of diabetes, including retinopathy and neuropathy. Patients should be monitored closely, especially during the first 3 months post-transplant, and treated aggressively, should glucose intolerance be detected. Minimization of immunosuppression dose, diet, oral hypoglycemic agents, and insulin have all been used in the treatment of PTDM, however, the insulin-sensitizing agents have not been studied. It is hoped that newer immunosuppressive regimens and, ultimately, the ability to achieve tolerance will eventually solve the problem of PTDM.
Current Developments in Nutrition, 2020
Objectives We compared beliefs about plant-based eating and dietary intake in patients attending ... more Objectives We compared beliefs about plant-based eating and dietary intake in patients attending inner-City CKD and Family Medicine (FM) clinics. Methods A face-to-face survey was conducted in a random convenience sample of pts in CKD (23) and FM clinics (22). Patients were asked to answer 5 multiple choice questions assessing their beliefs regarding difficulty in finding plant-based foods in restaurants, affordability, ability to get proteins and vitamins, and ability to find good tasting recipes. A mean score was calculated. Lower score indicates more difficulty (PBE-score). Diet analysis was based on 24hr recall and analyzed using ASA-24 software. Comparisons are by t-test unless noted. Results Mean age was 54.3 ± 2.5 yrs. There were 16 (35.6%) males and 22 (62.2%) females with 40 black (89%). 36 (80%) had not completed college. 23 (51%) had an income < $20 K. 16 (35%) were employed. 20 (44%) had diabetes. 22 (49%) received SNAP benefits. Mean BMI was 30.4 ± 1.6 with 41% > ...
Current Developments in Nutrition
Objectives This case illustrates the importance of screening for food insecurity during outpatien... more Objectives This case illustrates the importance of screening for food insecurity during outpatient visits. According to the USDA Economic Research Service, food insecurity affected approximately 38.3 million people in the United States during 2020. Health outcomes studies have shown that food insecurity is associated with increased rates of mental health problems and poor outcomes on health exams in non-senior adults, but only a minority of healthcare professionals regularly screen for food insecurity in their patients. Methods A 53-year-old woman with no significant past medical history presented to a student-run free clinic for evaluation of shoulder. The patient was unemployed, had lost weight unintentionally, and was a vegetarian with meals that consisted of vegetables, beans, and nuts. She mentioned that she fasted multiple times a month, describing it as “detoxing,” but also alluding to financial reasons for her dietary choices. The team proceeded to ask more direct questions ...
Current Developments in Nutrition
Objectives Pts who receive hemodialysis require strict dietary restrictions and have encountered ... more Objectives Pts who receive hemodialysis require strict dietary restrictions and have encountered increased difficulties due to COVID-19. We examined food purchasing patterns and dietary intake during the pandemic in a population of inner-city dialysis patients. Methods A random sample of 32 dialysis patients were surveyed regarding general food purchasing habits and changes due to COVID-19. Dietary intake was assessed using 24-hour food recall and analyzed using ASA-24. Results Mean age was 56.8 ± 18.2 years. Mean dialysis time was 88.0 ± 104.0 months. There were 20 (62.5%) male, 29 (90.6%) identified as black, 18 (56%) had a high school diploma or less, and 14 (44%) completed some college or more. Mean calories was 1438.0 ± 650.5 kcal, protein was 70.2 ± 39.7 g, fat was 52.5 ± 29.6 g, carbohydrate was 173.3 ± 92.5 g, and phosphorus was 986.0 ± 537.7 mg. 11 pts purchased breakfast rather than making it at home at least once a week (PUR). Calories (1686.2 ± 674.0 vs. 1031.8 ± 346.7, ...
Current Developments in Nutrition
Objectives The COVID-19 pandemic created nutritional stressors in indigent patients, especially t... more Objectives The COVID-19 pandemic created nutritional stressors in indigent patients, especially those with diets prescribed for chronic disease. We studied use of SNAP benefits and how food purchasing behavior was affected in a cohort of inner-city dialysis patients during the past year. Methods 33 dialysis patients were surveyed face to face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over 12 months prior to the summer of 2021. The survey also assessed patient attitudes and fears relating to food purchasing due to COVID-19. Results Mean age was 57.1 ± 17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under 20,000with7020,000 with 70% less than 20,000with7040,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p = 0.019). Age correlated inversely with feeling safe eating at a restaurant indoors (r = −0.47, p = 0.008), or outdoors (r = −0.58, p = <...
Current Developments in Nutrition
Objectives PBE may result in healthier eating in both patients on hemodialysis and those with oth... more Objectives PBE may result in healthier eating in both patients on hemodialysis and those with other advanced kidney diseases, with increased phosphorous and potassium allowances as well as lower acid load. Understanding interest in and beliefs regarding plant based eating (PBE) in an underserved inner-city pt population with kidney disease may help tailor healthier eating plans based on PBE. Methods A random sample of 33 dialysis and 22 kidney transplant pts in an inner-city environment were surveyed regarding beliefs about PBE and dietary intake by 24-hour recall using the ASA24 database. Results did not differ between populations so they were analyzed together. Not all pts completed all questions. Results Mean age was 55.3 ± 2.1 yrs, 54% male (30); 88% (49) identified as Black, 36% US-born (20); 77% (30) reported annual income <$40K, 64% (35) did not finish college. 8/28 (29%) reported having tried PBE, and 22/39 (57%) were interested. 52% of patients (29) reported not having b...
Circulation: Cardiovascular Quality and Outcomes, 2011
Nonadherence is a problem in pts with HF. Negative belief about the specific necessity of medicat... more Nonadherence is a problem in pts with HF. Negative belief about the specific necessity of medications (SNmed) correlates with nonadherence in the general population. Studies have suggested that medication beliefs are culture specific. Many minority pts have negative med beliefs and distrust the healthcare system. This has been correlated with lower levels of adherence. High levels of SNmed have been demonstrated in asthmatics and correlate with adherence, which may be attributed to relationship of med use and symptom relief. 41 pts with HF whose symptom relief might also be related to med usage were compared with 79 kidney transplant recipients (KTR), whose transplant meds do not directly affect their symptoms, using the Beliefs in Medicine Questionnaire, which examines beliefs regarding necessity, overuse and general harm of prescribed meds using a 5 point Likert scale. The possible range for SNmed is 5-25, higher scores indicate more positive beliefs. There were 108/120 (90%) Blac...
Current Developments in Nutrition, 2021
Objectives We examined the impact of the COVID19 pandemic on dietary intake in an inner-city popu... more Objectives We examined the impact of the COVID19 pandemic on dietary intake in an inner-city population of CKD and KTx patients. Methods Dietary intake was assessed using 24-hour recall in a random sample of patients from CKD and Transplant clinics in 2019 (48) and in 2020 (30). Dietary assessments were conducted in person in 2019 and by phone in 2020. Diets were analyzed using ASA-24 software. Entries with less than 1,100 kcal were excluded from analysis. There was no difference in patterns between the two clinics so they were analyzed together. Statistical analysis was by t-test or Chi-square as appropriate. Results The 2019 cohort and the 2020 cohort were similar for age (55.9 ± 12.5 vs 60.0 ± 11.7, P = 0.148), gender (60.4% vs 43.3% male, P = 0.141), race (81.3% vs 69.2% Black, P = 0.241), and education (75% vs 80.8% with less than a college degree, P = 0.573). The 2020 patients consumed fewer total calories (1513.16 ± 350.82 vs 1731.02 ± 573.07 kcal, P = 0.041) compared to 2019...
Journal of the American Society of Nephrology, 1997
Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hy... more Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hyperparathyroidism may persist or develop after renal transplantation and eventually require parathyroidectomy. Avid calcium retention by demineralized bones (hungry bone syndrome) is well-recognized after parathyroidectomy and usually resolves after a few weeks. This report documents the case of a renal transplant recipient with persistent hyperparathyroidism who developed a pathological fracture of the pelvis and required parathyroidectomy 1 year after transplant and then manifested severe and prolonged hungry bone syndrome lasting for more than 20 months postoperatively. The clinical features and treatment of hyperparathyroidism in renal transplant recipients are discussed, as are diagnosis, pathogenesis, and management of hungry bone syndrome. Recognition of renal transplant recipients at greater risk for severe hungry bone syndrome should permit earlier and more aggressive management...