Clin-STAR Journey Story

Building a Network to Understand the Unique Needs of Older Adults in Kidney Transplantation

Mara A. McAdams DeMarco, PhD, is an Associate Professor in both the Department of Surgery and the Department of Population Health at New York University Grossman School of Medicine. As an epidemiologist, her interest in older adults arose during work on her PhD dissertation. “I became really interested in aging and kidney disease and began collaborating with transplant surgeon Dorry Segev, MD, PhD, who had just launched the first study of frailty in kidney transplantation.” Right away, she was struck by “the lack of information” to guide the care of older kidney transplant patients.

“When I began my career, all of the clinical guidelines and policies about kidney transplantation were derived from younger adults, despite the significant increase in the number of older adults receiving transplants,” she said. “The guidelines weren’t taking into consideration physical functioning, frailty, cognitive function, delirium, or any of the things that now—15 years later—we recognize as important.”

For the transplant population, she believes that frailty presents either as primary frailty, which is related to aging, or as secondary frailty, which is related to kidney disease. For patients who have frailty caused by their kidney disease, transplantation reverses it. “We see something similar for cognition as well,” she said. “Our results show substantial improvements in physical functioning, frailty, and cognitive function for both younger and older adults who were either frail or cognitively impaired at the time of kidney transplantation.”

Broadening her research focus from a patient orientation to more systemic clinical practice, Dr. McAdams DeMarco participated in a national survey of transplant centers as part of a consensus conference on frailty led by the American Society of Transplantation. Of the transplant centers surveyed, approximately two-thirds reported that they measured frailty during transplant evaluations. “So, we knew which centers were measuring frailty. What if we came back a year later to see if that made a difference?” she said. “What we saw was pretty dramatic.” Centers that measured frailty reported about an 18% reduction in mortality before kidney transplantation and a 29% improvement in overall patient outcomes afterwards. “We saw that frailty was an important part of clinical decision-making that improved both pre- and post-transplant outcomes, particularly for older adults.”

This research received a series of grants from the National Institute on Aging (NIA), including early- and mid-career development grants for Dr. McAdams DeMarco. These allowed her to expand her research focus—and her vision—beyond clinical practice. She knew that measuring frailty aided clinical decision-making and that coordinated research would improve patient care. Around the same time, her colleague Rasheeda Hall, MD, MBA, MHS, a nephrologist at Duke, was entertaining a similar idea. Their discussions unveiled a shared vision: to build a network of geriatric nephrology researchers in the United States and beyond. In 2022, the Kidney Disease and Aging Research Collaborative (KDARC) was born.

“We launched this Collaborative with no funding,” she said. “Only our blood, sweat, and tears.” They identified investigators in geriatric nephrology and asked them to “invite their friends.” With 27 research sites in the United States and Canada, KDARC assembled 45 investigators across disciplines, including epidemiologists, nephrologists, transplant surgeons, and geriatricians.

“Within a year, NIA released an infrastructure funding opportunity to support investigators conducting just this type of research. KDARC was now aligned with NIA’s research priorities,” she said. She and Dr. Hall submitted the proposal, and it was awarded July 2024. This NIA funding will help KDARC members both launch and advance their research careers in geriatric nephrology. “We’ll be able to provide mentorship, pilot grants, and training. With the coordinating center at NYU, we’ll offer a one stop shop if you’re looking to launch studies in this field or if you want to add the novel layer of aging to your existing nephrology study.”

Dr. McAdams DeMarco cites the Clin-STAR Coordinating Center as a source of inspiration. “That was our model for KDARC,” she said. “Clin-STAR has so many great resources, trainings, and grant opportunities. For mentorship specifically within KDARC, we’ll pair early career faculty members with more senior investigators in nephrology and geriatric nephrology research.”

KDARC is always seeking new members. “Any faculty member who would like to be a part of this,” she said, “we’re more than happy to have them involved.” Dr. McAdams DeMarco also regularly shares her experience with fellow investigators about building a research consortium. “We’ve put together a nice group of like-minded folks,” she said, “Any of the lessons that we’ve learned, we’re really happy to pass on.”