COVID-19 Vaccine Uptake in Undocumented Latinx Patients Presenting to the Emergency Department.

This cross-sectional study examines COVID-19 infection status, vaccination uptake, and perceptions about the vaccine among Latinx patients presenting to the emergency department in California.

Muscle Mass and Serum Creatinine Concentration by Race and Ethnicity among Hemodialysis Patients.

SIGNIFICANCE STATEMENT: Serum creatinine is a product of skeletal muscle metabolism. Differences in serum creatinine concentration between Black and non-Black individuals have been attributed to differences in muscle mass but have not been thoroughly examined. Furthermore, other race and ethnic groups have not been considered. If differences in body composition explain differences in serum concentration by race or ethnicity, then estimates of body composition could be used in eGFR equations rather than race. Adjustment for intracellular water (ICW) as a proxy of muscle mass among patients with kidney failure in whom creatinine clearance should minimally influence serum concentration does not explain race- and ethnicity-dependent differences. BACKGROUND: Differences in serum creatinine concentration among groups defined by race and ethnicity have been ascribed to differences in muscle mass. We examined differences in serum creatinine by race and ethnicity in a cohort of patients receiving hemodialysis in whom creatinine elimination by the kidney should have little or no effect on serum creatinine concentration and considered whether these differences persisted after adjustment for proxies of muscle mass. METHODS: We analyzed data from 501 participants in the A Cohort Study to Investigate the Value of Exercise in ESKD/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESKD study who had been receiving hemodialysis for >1 year. We examined the independent associations among race and ethnicity (Black, Asian, non-Hispanic White, and Hispanic), serum creatinine, and ICW (L/m 2 ), a proxy for muscle mass, derived by whole-body multifrequency bioimpedance spectroscopy, using multivariable linear regression with adjustment for several demographic, clinical, and laboratory characteristics. We examined the association of race and ethnicity with serum creatinine concentration with and without adjustment for ICW. RESULTS: Black, Asian, and Hispanic patients had higher serum creatinine concentrations (+1.68 mg/dl [95% confidence interval (CI), 1.09 to 2.27], +1.61 mg/dl [95% CI, 0.90 to 2.32], and +0.83 [95% CI, 0.08 to 1.57], respectively) than non-Hispanic White patients. Overall, ICW was associated with serum creatinine concentration (0.26 mg/dl per L/m 2 ICW; 95% CI, 0.006 to 0.51) but was not statistically significantly different by race and ethnicity. Black, Asian, and Hispanic race and ethnicity remained significantly associated with serum creatinine concentration after adjustment for ICW. CONCLUSION: Among patients receiving dialysis, serum creatinine was higher in Black, Asian, and Hispanic patients than in non-Hispanic White patients. Differences in ICW did not explain the differences in serum creatinine concentration across race groups.

Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation.

Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.

Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Chronic kidney disease (CKD) affects over 850 million people globally, and the need to prevent its development and progression is urgent. During the past decade, new perspectives have arisen related to the quality and precision of care for CKD, owing to the development of new tools and interventions for CKD diagnosis and management. New biomarkers, imaging methods, artificial intelligence techniques, and approaches to organizing and delivering healthcare may help clinicians recognize CKD, determine its etiology, assess the dominant mechanisms at given time points, and identify patients at high risk for progression or related events. As opportunities to apply the concepts of precision medicine for CKD identification and management continue to be developed, an ongoing discussion of the potential implications for care delivery is required. The 2022 KDIGO Controversies Conference on Improving CKD Quality of Care: Trends and Perspectives examined and discussed best practices for improving the precision of CKD diagnosis and prognosis, managing the complications of CKD, enhancing the safety of care, and maximizing patient quality of life. Existing tools and interventions currently available for the diagnosis and treatment of CKD were identified, with discussion of current barriers to their implementation and strategies for improving the quality of care delivered for CKD. Key knowledge gaps and areas for research were also identified.

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research.

BACKGROUND: Latinx individuals are disproportionally burdened by kidney diseases compared to non-Latinx White individuals and are underrepresented in kidney-related research. We aimed to describe stakeholder perspectives on Latinx patient engagement in kidney-related research. METHODS: We conducted a thematic analysis of two online moderated discussions and an interactive online survey with open-text responses involving participants (i.e. stakeholders), with personal and/or professional experiences with Latinx patients with kidney diseases and their families/caregivers. RESULTS: Among the eight stakeholders (Female:75%; Latinx ethnicity:88%), there were three physicians, one nurse, one patient with kidney disease who received a kidney transplant, one policy maker, one Doctor of Philosophy, and one executive director of a non-profit health organization. We identified five themes. The majority of themes and their respective subthemes (in parentheses) reflected barriers to engagement: Lack of personal relevance (unable to relate to research staff and marketing resources, and unclear benefit of research to self, family, and community); fear and vulnerability (immigration concerns, stigma with seeking care, skepticism of Western medicine); logistical and financial barriers (limited opportunities to enroll in clinical trials, out-of-pocket costs, transportation issues); and distrust and asymmetry of power (related to limited English proficiency or health literacy, and provider bias). The last theme centered on stimulating interest and establishing trust in the research process. CONCLUSIONS: To overcome barriers to engagement in kidney-related research and establish trust among potential Latinx research participants, stakeholders recommended employing cultural responsiveness and community-based strategies. These strategies can help identify local health priorities, enhance research recruitment and retention strategies, and establish partnerships that continue to elevate research endeavors aiming to enhance the health of Latinx individuals with kidney diseases.

Hernioplastia inguinal de Jean Rives modificada / Modified Jean Rives Inguinal Hernioplasty

Introducción: Las intervenciones quirúrgicas de hernias son uno de los procedimientos que más frecuente realizan los cirujanos. Objetivo: Caracterizar a los pacientes a los que les fue realizada la técnica quirúrgica de hernioplastia inguinal según la técnica de Jean Rives modificada. Métodos: Se realizó un estudio descriptivo retrospectivo de corte longitudinal en el Hospital Universitario Arnaldo Milián Castro de Santa Clara en el período de enero del 2011 a diciembre del 2021. El universo de trabajo estuvo representado por la población de pacientes con el diagnóstico de hernias inguinocrurales, a los cuales les fue efectuada dicha técnica quirúrgica. La muestra estuvo conformada por 194 pacientes. Resultados: Predominó el sexo masculino 103 (53,1 por ciento) y los pacientes mayores de 60 años 99 (51,0 por ciento). La localización más frecuente de la hernia fue la zona inguinal derecha 146 (75,3 por ciento) para ambos sexos, masculino 81 (41,8 por ciento) y femenino 65 (33,5 por ciento) respectivamente. Prevalecieron las hernias inguinales primarias 96 (49,5 por ciento), directas 70 (36,1 por ciento); en el sexo masculino preponderaron las indirectas 61 (31,4 por ciento). Predominaron las complicaciones posoperatorias en las cirugías de urgencias 10 (5,0 por ciento). El seroma 4 (2,0 por ciento), la orquitis 3 (1,5 por ciento) y la recidiva herniaria 3 (1,5 por ciento) fueron las complicaciones más comunes. Conclusiones: La técnica de hernioplastia inguinocrural de Jean Rives modificada es efectiva para los pacientes masculinos mayores de 60 años con hernias inguinales primarias, directas e indirectas. Las posibles complicaciones posoperatorias fueron en las intervenciones quirúrgicas de urgencia, donde el seroma y la orquitis fueron las más frecuentes. La recidiva tuvo una baja tasa con respecto a otros tipos de hernioplastias(AU)

Introduction: Hernia surgical interventions are one of the procedures most frequently performed by surgeons. Objective: To characterize the patients who underwent the surgical technique of inguinal hernioplasty based on the modified Jean Rives technique. Methods: A retrospective, descriptive and longitudinal study was carried out in Hospital Universitario Arnaldo Milián Castro, of Santa Clara City, central Cuba, in the period from January 2011 to December 2021. The study universe was represented by the population of patients diagnosed with inguinocrural hernias who underwent this surgical technique. The sample consisted of 194 patients. Results: There was a predominance of the male sex, accounting for 103 (53.1 percent); as well as of patients over 60 years of age, accounting for 99 (51.0 percent). The most frequent location of the hernia was the right inguinal area, represented by 146 cases (75.3 percent) for both sexes, accounting for 81 (41.8 percent) and 65 (33.5 percent) for males and females, respectively. Primary inguinal hernias predominated, represented by 96 cases (49.5 percent); as well as direct hernias, accounting for 70 cases (36.1 percent). In the male sex, indirect hernias predominated, accounting for 61 cases (31.4 percent). Postoperative complications predominated in emergency surgery, represented by 10 cases (5.0 percent). Seroma (4; 2.0 percent), orchitis (3; 1.5 percent) and hernia recurrence (3; 1.5 percent) were the most common complications. Conclusions: The modified Jean Rives inguinocrural hernioplasty technique is effective for male patients older than 60 years with primary, direct and indirect inguinal hernias. Potential postoperative complications occurred in emergency surgery, in which cases seroma and orchitis were the most frequent ones. Recurrence had a low rate compared to other types of hernioplasties(AU)

Supervivencia de pacientes con cáncer de mama y cirugía conservadora / Survival in Patients with Breast Cancer and Conservative Surgery

Introducción: En la actualidad la cirugía conservadora, más que una opción en el tratamiento quirúrgico del cáncer de mama, es la técnica quirúrgica de elección. Objetivo: Caracterizar la supervivencia de los pacientes con cáncer de mama operados con cirugía conservadora. Métodos: Se realizó un estudio multicéntrico, retrospectivo descriptivo de corte longitudinal, en el Hospital Universitario Clínico Quirúrgico "Arnaldo Milián Castro" y el oncológico "Celestino Hernández Robau", ambos de la ciudad de Santa Clara provincia Villa Clara, en el período comprendido desde enero del 2011 hasta diciembre del 2020. Resultados: La supervivencia global de los pacientes con cáncer de mama y cirugía conservadora en aquellos que presentaron eventos (fallecidos) fue mayor en los portadores de carcinoma ductal infiltrante con 9,3 años. En el caso del estadio tumoral predominó la supervivencia en aquellos pacientes que estaban en estadios Ia y IIa con 9,8 y 9,1 años, respectivamente. Según la inmunohistoquímica, el subtipo molecular con mejor supervivencia global fue el Luminal B con 9,2 años. En cuanto al tratamiento definitivo aplicado presentaron mayor supervivencia global aquellos pacientes que recibieron esquemas de quimioterapia+ radioterapia+ hormono terapia y quimioterapia+ radioterapia con 9,4 y 8,8 años, respectivamente. Conclusiones: Existe una mayor supervivencia global en aquellos pacientes con carcinoma ductal infiltrantes (NOS), estadios tumorales Ia y IIa, con subtipo molecular Luminal B según inmunohistoquímica y con tratamientos definitivos de quimioterapia+ radioterapia+ hormonoterapia(AU)

Introduction: Nowadays, conservative surgery, rather than an option for the surgical treatment of breast cancer, is the surgical technique of choice. Objective: To characterize the survival of patients with breast cancer operated on with conservative surgery. Methods: A multicenter, retrospective, descriptive and longitudinal study was carried out at Hospital Universitario Clínico Quirúrgico "Arnaldo Milián Castro" and "Celestino Hernández Robau" oncologic hospital, both in the city of Santa Clara, Villa Clara Province, in the period from January 2011 to December 2020. Results: The overall survival of patients with breast cancer and conservative surgery in those who presented events (died) was higher in those with infiltrating ductal carcinoma, accounting for 9.3 years. In the case of tumor stage, survival was predominant in those patients with stages IA and IIA, accounting for 9.8 and 9.1 years, respectively. Concerning immunohistochemistry, the molecular subtype with the best overall survival was Luminal B, accounting for 9.2 years. Regarding the applied definitive treatment, those patients who received chemotherapy-radiotherapy-hormone therapy and chemotherapy-radiotherapy schemes presented better overall survival, accounting for 9.4 and 8.8 years, respectively. Conclusions: Overall survival is higher in patients with infiltrating ductal carcinoma (not otherwise specified), tumor stages IA and IIA, molecular subtype Luminal B according to immunohistochemistry, and definitive treatments with chemotherapy, radiotherapy, hormone therapy scheme(AU)

Mental health nurses' resilience in the context of emotional labour: An interpretive qualitative study.

Strengthening mental health nurses' (MHNs) resilience may help mitigate the negative effects of the emotional labour (EL) of their work. There is no prior evidence on MHNs' experiences of resilience in the context of EL. This interpretive qualitative study sought to explore how MHNs build and maintain their resilience in the face of high levels of EL. Semi-structured interviews were conducted with 11 MHNs. Reflexive thematic analysis was used to analyse the data. Four main themes were constructed. The first three; Being attuned to self and others, Having a positive mindset grounded in purpose, and Maintaining psychological equilibrium through proactive self-care, describe how MHNs build and maintain their resilience. The fourth theme, Running on emotionally empty, describes what impedes MHNs' resilience. MHNs engaged in internal self-regulatory processes to manage their mental and emotional state. They maintained intra- and inter-personal boundaries and proactively used self-care strategies to maintain their well-being. Through this, they were able to replenish and sustain the energy required to maintain a state of equilibrium between themselves, their interpersonal practice, and their working environment, and to positively adapt to EL. However, lack of organizational support and high workplace demands can negatively impact MHNs' equilibrium and adaptive ability. There is a need for organizations to proactively work to reduce workplace stressors, and support MHNs' professional well-being and practice. Education and support strategies focused on strengthening MHNs' resilience, well-being, and mental health practice capabilities, including the provision of clinical supervision, and clear role expectations within MHNs' scope of practice are recommended.

Resolving the Debate: The Future of Using Race in Estimating Kidney Function.

Racial and social unrest witnessed during 2020 ignited a national conversation about the appropriateness of the use of race in health care algorithms and in the estimation of kidney function in particular. The growing concerns over the use of race in kidney function-estimating equations prompted the National Kidney Foundation (NKF) and American Society of Nephrology to launch an effort for change by establishing a task force on reassessing the use of race in diagnosing kidney disease. After nearly a year examining the evidence and obtaining testimony from experts and stakeholders, the task force recommended the immediate implementation of the 2020 Chronic Kidney Disease-Epidemiology creatinine equation refit without race in all US laboratories; increased routine use of cystatin C for confirmation of estimated glomerular filtration rate in clinical decision-making and a call for research on glomerular filtration rate estimation with new endogenous filtration markers and on addressing disparities in health and health care. The NKF and American Society of Nephrology strongly encouraged rapid adoption of these new recommendations. Leadership efforts of the NKF have begun to lay the foundation for national implementation through laboratory engagement, clinician awareness, and patient education.

The removal of race from kidney function estimation: Key points for primary providers.

Recent recognitions of longstanding societal effects of structural and overt acts of racism have led to calls for the elimination of race, a social construct, from medical algorithms. This accelerated a growing concern with the use of race in kidney function estimating equations. A task force sponsored by the two leading nephrology societies in the United States has reassessed the inclusion of race in glomerular filtration rate (GFR) estimation and recently put forth recommendations. New race-free equations have been developed and guides for widespread implementation have been provided. We herein review the journey of kidney function estimating equations, race in GFR estimating equations, new race-free equations and the path forward in caring for chronic kidney disease. We urge upon all primary care providers to employ concerted focus on early detection and identification of kidney dysfunction as well as risk factors including social determinants of health to prevent progression.

A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease.

BACKGROUND: In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of glomerular filtration rate (GFR) in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS & DELIBERATIONS: The Task Force organized its activities over 10 months in phases to (1) clarify the problem and evidence regarding GFR estimating equations in the United States (described previously in an interim report), and, in this final report, (2) evaluate approaches to address use of race in GFR estimation, and (3) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to 5 of those approaches. We holistically evaluated each approach considering 6 attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS: (1) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. (2) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm estimated GFR in adults who are at risk for or have chronic kidney disease, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. (3) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION: This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.

Longitudinal Assessment of Body Composition and Its Association With Survival Among Participants of the ACTIVE/ADIPOSE Study.

OBJECTIVES: The importance of muscle wasting as a predictor of mortality in the hemodialysis population is not clear. Lack of association of muscle mass with survival in some studies could be related to reliance on single measures or to incorporation of excess extracellular water (ECW) into estimates of muscle mass. We examined changes in body composition over a 2-year period and the association of body composition with survival. DESIGN AND METHODS: We analyzed data from 325 adults receiving hemodialysis in the Bay Area. We estimated ECW, intracellular water (ICW), and fat mass by whole-body bioimpedance spectroscopy (BIS) at 0, 12, and 24 months from enrollment. We used linear mixed modeling to examine changes in body mass index and BIS-derived estimates of body composition and Cox modeling with BIS-derived estimates as time-varying independent variables to examine associations between body composition and survival in multivariable analyses. RESULTS: Body mass index declined over time. Considering individual components of body composition, ICW declined (-0.09 kg/m2 per year, 95% confidence interval -0.14 to -0.04), but fat mass and ECW did not change significantly. There were 120 deaths over a median of 5.2 years. The relationship between ICW and mortality was not linear such that the association was steeper at low values of ICW, whereas higher ICW was associated with better survival that was relatively stable above 9 kg/m2. Higher ECW was associated with higher mortality, and fat mass was not associated with survival. These associations were independent of markers of inflammation and nutritional status. CONCLUSIONS: ICW declined over 2 years in this cohort, whereas fat mass and ECW remained relatively stable. Higher ICW was associated with better survival, but higher fat mass was not. Higher ECW was associated with worse survival. These results suggest that muscle mass may predict survival among patients on hemodialysis.

A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease.

BACKGROUND: In response to a national call for re-evaluation of the use of race in clinical algorithms, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a Task Force to reassess inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and management of patients with, or at risk for, kidney diseases. PROCESS DELIBERATIONS: The Task Force organized its activities over 10 months in phases to ( 1 ) clarify the problem and evidence regarding eGFR equations in the United States (described previously in an interim report), and, in this final report, ( 2 ) evaluate approaches to address use of race in GFR estimation, and ( 3 ) provide recommendations. We identified 26 approaches for the estimation of GFR that did or did not consider race and narrowed our focus, by consensus, to five of those approaches. We holistically evaluated each approach considering six attributes: assay availability and standardization; implementation; population diversity in equation development; performance compared with measured GFR; consequences to clinical care, population tracking, and research; and patient centeredness. To arrive at a unifying approach to estimate GFR, we integrated information and evidence from many sources in assessing strengths and weaknesses in attributes for each approach, recognizing the number of Black and non-Black adults affected. RECOMMENDATIONS: ( 1 ) For US adults (>85% of whom have normal kidney function), we recommend immediate implementation of the CKD-EPI creatinine equation refit without the race variable in all laboratories in the United States because it does not include race in the calculation and reporting, included diversity in its development, is immediately available to all laboratories in the United States, and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals. ( 2 ) We recommend national efforts to facilitate increased, routine, and timely use of cystatin C, especially to confirm eGFR in adults who are at risk for or have CKD, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either marker alone. If ongoing evidence supports acceptable performance, the CKD-EPI eGFR-cystatin C (eGFRcys) and eGFR creatinine-cystatin C (eGFRcr-cys_R) refit without the race variables should be adopted to provide another first-line test, in addition to confirmatory testing. ( 3 ) Research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded. An investment in science is needed for newer approaches that generate accurate, unbiased, and precise GFR measurement and estimation without the inclusion of race, and that promote health equity and do not generate disparate care. IMPLEMENTATION: This unified approach, without specification of race, should be adopted across the United States. High-priority and multistakeholder efforts should implement this solution.

Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention.

INTRODUCTION: A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS: Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS: One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION: Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.