Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 14, Issue 4, Pages 576-582Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.12921118
Keywords
outcomes; renal dialysis; kidney transplantation; Walking Speed; Accidental Falls; Outpatients; Prospective Studies; Frailty; Weight Loss; risk factors; Incidence; Kidney Failure; Chronic; Comorbidity; hospitalization; Transplants; Cognition; Hand Strength; Counseling
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Disease
- National Institute of Aging [T32DK007732, F32AG053025, F32DK109662, K23DK115908 01, K24DK101828, R01AG055781, R01DK114074, K01AG043501]
Ask authors/readers for more resources
Background and objectives Frailty, a syndrome distinct from comorbidity and disability, is clinically manifested as a decreased resistance to stressors and is present in up to 35% of patient with ESKD. It is associated with falls, hospitalizations, poor cognitive function, and mortality. Also, frailty is associated with poor outcomes after kidney transplant, including delirium and mortality. Frailty is likely also associated with decreased access to kidney transplantation, given its association with poor outcomes on dialysis and post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought to quantify if frail kidney transplant candidates had similar access to kidney transplantation as nonfrail candidates. Design, setting, participants, & measurements We studied 7078 kidney transplant candidates (2009-2018) in a three-center prospective cohort study of frailty. Fried frailty (unintentional weight loss, grip strength, walking speed, exhaustion, and activity level) was measured at outpatient kidney transplant evaluation. We estimated time to listing and transplant rate by frailty status using Cox proportional hazards and Poisson regression, adjusting for demographic and health factors. Results The mean age was 54 years (SD 13; range, 18-89), 40% were women, 34% were black, and 21% were frail. Frail participants were almost half as likely to be listed for kidney transplantation (hazard ratio, 0.62; 95% confidence interval, 0.56 to 0.69; P<0.001) compared with nonfrail participants, independent of age and other demographic factors. Furthermore, frail candidates were transplanted 32% less frequently than nonfrail candidates (incidence rate ratio, 0.68; 95% confidence interval, 0.58 to 0.81; P<0.001). Conclusions Frailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available