Mara McAdams-DeMarco

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Are you Mara McAdams-DeMarco?

Claim your profile

Publications (40)191 Total impact

  • Elizabeth King · Lauren Kucirka · Mara McAdams-DeMarco · Allan Massie · Dorry Segev

    No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation
  • Mara McAdams-DeMarco · Xun Luo · Babak Orandi · Dorry Segev

    No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation

  • No preview · Article · Jan 2016 · American Journal of Transplantation
  • Elizabeth King · Lauren Kucirka · Mara McAdams-DeMarco · Allan Massie · Dorry Segev

    No preview · Article · Jan 2016 · American Journal of Transplantation
  • Elizabeth King · Lauren Kucirka · Mara McAdams-DeMarco · Allan Massie · Dorry Segev

    No preview · Article · Jan 2016 · American Journal of Transplantation
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. Methods: We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population-based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. Results: The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63-6.63) increased gout risk in older age. Conclusions: These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age.
    No preview · Article · Dec 2015 · The Journals of Gerontology Series A Biological Sciences and Medical Sciences
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The effects of carbohydrates on plasma uric acid levels are controversial. We determined the individual and combined effects of carbohydrate quality (glycemic index, GI) and quantity (proportion of total daily energy, %carb) on uric acid. Methods: We conducted a randomized, crossover feeding trial in overweight or obese adults without cardiovascular disease (N=163). Participants were fed each of four diets over 5-week periods separated by 2-week washout periods. Body weight was kept constant. The four diets were: high GI (GI ≥65) with high %carb (58% kcal), low GI (GI ≤45) with low %carb (40% kcal), low GI with high %carb; and high GI with low %carb. Plasma uric acid was measured at baseline and after each feeding period for comparison between the 4 diets. Results: Study participants were 52% women and 50% non-Hispanic black with a mean age of 52.6 years and a mean uric acid of 4.7 (SD, 1.2) mg/dL. Reducing GI lowered uric acid when the %carb was low (-0.24 mg/dL; P <0.001) or high (-0.17 mg/dL; P <0.001). Reducing the %carb marginally increased uric acid only when GI was high (P = 0.05). The combined effect of lowering GI and increasing the %carb was -0.27 mg/dL (P <0.001). This effect was observed even after adjustment for concurrent changes in kidney function, insulin sensitivity, and products of glycolysis. Conclusions: Reducing GI lowers uric acid. Future studies should examine whether reducing GI can prevent gout onset or flares. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Arthritis and Rheumatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disparities in access to kidney transplantation (KT) remain inadequately understood and addressed. Detailed descriptions of patient attitudes may provide insight into mechanisms of disparity. The aims of this study were to explore perceptions of dialysis and KT among African American adults undergoing hemodialysis, with particular attention to age- and sex-specific concerns. Qualitative data on experiences with hemodialysis and views about KT were collected through four age- and sex-stratified (males <65, males ≥65, females <65, and females ≥65 years) focus group discussions with 36 African American adults recruited from seven urban dialysis centers in Baltimore, Maryland. Four themes emerged from thematic content analysis: 1) current health and perceptions of dialysis, 2) support while undergoing dialysis, 3) interactions with medical professionals, and 4) concerns about KT. Females and older males tended to be more positive about dialysis experiences. Younger males expressed a lack of support from friends and family. All participants shared feelings of being treated poorly by medical professionals and lacking information about renal disease and treatment options. Common concerns about pursuing KT were increased medication burden, fear of surgery, fear of organ rejection, and older age (among older participants). These perceptions may contribute to disparities in access to KT, motivating granular studies based on the themes identified.
    Full-text · Article · Dec 2015 · BMC Nephrology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and objectives Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD. Design, setting, participants, & measurements At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models. Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3M5: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (-2.8 points; 95% CI, -5.4 to -0.2; P=0.03). Conclusions In adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).
    No preview · Article · Nov 2015 · Clinical Journal of the American Society of Nephrology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Married couples might be an appropriate target for obesity prevention interventions. In the present study, we aimed to evaluate whether an individual's risk of obesity is associated with spousal risk of obesity and whether an individual's change in body mass index (BMI; weight in kilograms divided by height in meters squared) is associated with spousal BMI change. We analyzed data from 3,889 spouse pairs in the Atherosclerosis Risk in Communities Study cohort who were sampled at ages 45-65 years from 1986 to 1989 and followed for up to 25 years. We estimated hazard ratios for incident obesity by whether spouses remained nonobese, became obese, remained obese, or became nonobese. We estimated the association of participants' BMI changes with concurrent spousal BMI changes using linear mixed models. Analyses were stratified by sex. At baseline, 22.6% of men and 24.7% of women were obese. Nonobese participants whose spouses became obese were more likely to become obese themselves (for men, hazard ratio = 1.78, 95% confidence interval: 1.30, 2.43; for women, hazard ratio = 1.89, 95% confidence interval: 1.39, 2.57). With each 1-unit increase in spousal BMI change, women's BMI change increased by 0.15 (95% confidence interval: 0.13, 0.18) and men's BMI change increased by 0.10 (95% confidence interval: 0.09, 0.12). Having a spouse become obese nearly doubles one's risk of becoming obese. Future research should consider exploring the efficacy of obesity prevention interventions in couples.
    No preview · Article · Sep 2015 · American Journal of Epidemiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To understand the natural history of frailty after an aggressive surgical intervention, kidney transplantation (KT).DesignProspective cohort study (December 2008–March 2014).SettingBaltimore, Maryland.ParticipantsKidney transplantation recipients (N = 349).MeasurementsThe Fried frailty score was measured at the time of KT and during routine clinical follow-up. Using a Cox proportional hazards model, factors associated with improvements in frailty score after KT were identified. Using a longitudinal analysis, predictors of frailty score changes after KT were identified using a multilevel mixed-effects Poisson model.ResultsAt KT, 19.8% of recipients were frail; 1 month after KT, 33.3% were frail; at 2 months, 27.7% were frail; and at 3 months, 17.2% were frail. On average, frailty scores had worsened by 1 month (mean change 0.4, P < .001), returned to baseline by 2 months (mean change 0.2, P = .07), and improved by 3 months (mean change −0.3, P = .04) after KT. The only recipient or transplant factor associated with improvement in frailty score after KT was pre-KT frailty (hazard ratio = 2.55, 95% confidence interval (CI) = 1.71–3.82, P < .001). Pre-KT frailty status (relative risk (RR) = 1.49, 95% CI = 1.29–1.72, P < .001), recipient diabetes mellitus (RR = 1.26, 95% CI = 1.08–1.46, P = .003), and delayed graft function (RR = 1.22, 95% CI = 1.04–1.43, P = .02) were independently associated with long-term changes in frailty score.Conclusion After KT, in adult recipients of all ages, frailty initially worsens but then improves by 3 months. Although KT recipients who were frail at KT had higher frailty scores over the long term, they were most likely to show improvements in their physiological reserve after KT, supporting the transplantation in these individuals and suggesting that pretransplant frailty is not an irreversible state of low physiological reserve.
    No preview · Article · Sep 2015 · Journal of the American Geriatrics Society
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. We studied gout, hyperuricemia, and physical function in 5,819 older adults (age≥65) attending the 2011-2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity [Short Physical Performance Battery (SPPB) and 4 meter walking speed] and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalences of poor physical performance (first quartile) by gout and hyperuricemia were estimated using adjusted modified Poisson regression. 10% of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P=0.77). Participants with gout performed worse on the SPPB test; they had 0.77-times (95%CI:0.65,0.90; P=0.001) the prevalence odds of 1-unit increase in SPPB score and were 1.18-times (95%CI:1.07,1.32; P=0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference = -0.03, 95%CI:-0.05,-0.01; P<0.001) and were 1.19-times (95%CI:1.06,1.34; P=0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. Older adults with gout and hyperuricemia are more likely to have worse lower but not upper extremity function. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    No preview · Article · Jul 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Frailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate-perceived frailty-is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship. 146 adults undergoing hemodialysis were recruited from a single dialysis center in Baltimore, Maryland. Patient characteristics associated with perceived (reported by nephrologists, nurse practitioners (NPs), or patients) or measured frailty (using the Fried criteria) were identified using ordered logistic regression. The relationship between perceived and measured frailty was assessed using percent agreement, kappa statistic, Pearson's correlation coefficient, and prevalence of misclassification of frailty. Patient characteristics associated with misclassification were determined using Fisher's exact tests, t-tests, or median tests. Older age (adjusted OR [aOR] = 1.36, 95%CI:1.11-1.68, P = 0.003 per 5-years older) and comorbidity (aOR = 1.49, 95%CI:1.27-1.75, P < 0.001 per additional comorbidity) were associated with greater likelihood of nephrologist-perceived frailty. Being non-African American was associated with greater likelihood of NP- (aOR = 5.51, 95%CI:3.21-9.48, P = 0.003) and patient- (aOR = 4.20, 95%CI:1.61-10.9, P = 0.003) perceived frailty. Percent agreement between perceived and measured frailty was poor (nephrologist, NP, and patient: 64.1%, 67.0%, and 55.5%). Among non-frail participants, 34.4%, 30.0%, and 31.6% were perceived as frail by a nephrologist, NP, or themselves. Older adults (P < 0.001) were more likely to be misclassified as frail by a nephrologist; women (P = 0.04) and non-African Americans (P = 0.02) were more likely to be misclassified by an NP. Neither age, sex, nor race was associated with patient misclassification. Perceived frailty is an inadequate proxy for measured frailty among patients undergoing hemodialysis.
    Full-text · Article · Apr 2015 · BMC Geriatrics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Higher urate levels are associated with higher risk of CKD, but the association between urate and AKI is less established. This study evaluated the risk of hospitalized AKI associated with urate concentrations in a large population-based cohort. To explore whether urate itself causes kidney injury, the study also evaluated the relationship between a genetic urate score and AKI. A total of 11,011 participants from the Atherosclerosis Risk in Communities study were followed from 1996-1998 (baseline) to 2010. The association between baseline plasma urate and risk of hospitalized AKI, adjusted for known AKI risk factors, was determined using Cox regression. Interactions of urate with gout and CKD were tested. Mendelian randomization was performed using a published genetic urate score among the participants with genetic data (n=7553). During 12 years of follow-up, 823 participants were hospitalized with AKI. Overall, mean participant age was 63.3 years, mean eGFR was 86.3 ml/min per 1.73 m(2), and mean plasma urate was 5.6 mg/dl. In patients with plasma urate >5.0 mg/dl, there was a 16% higher risk of hospitalized AKI for each 1-mg/dl higher urate (adjusted hazard ratio, 1.16; 95% confidence interval, 1.10 to 1.23; P<0.001). When stratified by history of gout, the association between higher urate and AKI was significant only in participants without a history of gout (P for interaction=0.02). There was no interaction of CKD and urate with AKI, nor was there an association between genetic urate score and AKI. Plasma urate >5.0 mg/dl was independently associated with risk of hospitalized AKI; however, Mendelian randomization did not provide evidence for a causal role of urate in AKI. Further research is needed to determine whether lowering plasma urate might reduce AKI risk. Copyright © 2015 by the American Society of Nephrology.
    No preview · Article · Feb 2015 · Clinical Journal of the American Society of Nephrology
  • Mara McAdams-DeMarco · Elizabeth King · Babak Orandi · Nada Alachkar · Niraj Desai · Dorry Segev

    No preview · Conference Paper · Jan 2015

Publication Stats

177 Citations
191.00 Total Impact Points

Institutions

  • 2012-2015
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
    • Johns Hopkins University
      • • Department of Epidemiology
      • • Department of Medicine
      • • Department of Surgery
      Baltimore, Maryland, United States
  • 2013
    • Johns Hopkins Medicine
      • Department of Surgery
      Baltimore, Maryland, United States