Frailty and Access to Kidney Transplantation.
Accidental Falls
Cognition
Comorbidity
Counseling
Frailty
Hand Strength
Incidence
Kidney Failure, Chronic
Outpatients
Prospective Studies
Transplants
Walking Speed
Weight Loss
hospitalization
kidney transplantation
outcomes
renal dialysis
risk factors
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
05 04 2019
05 04 2019
Historique:
received:
01
11
2018
accepted:
01
02
2019
pubmed:
21
3
2019
medline:
10
7
2020
entrez:
21
3
2019
Statut:
ppublish
Résumé
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. 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. 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; Frailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.
Sections du résumé
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;
CONCLUSIONS
Frailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.
Identifiants
pubmed: 30890577
pii: 01277230-201904000-00015
doi: 10.2215/CJN.12921118
pmc: PMC6450348
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
576-582Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK007732
Pays : United States
Organisme : NIA NIH HHS
ID : K01 AG043501
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG055781
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK114074
Pays : United States
Organisme : NIA NIH HHS
ID : F32 AG053025
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK115908
Pays : United States
Organisme : NIDDK NIH HHS
ID : K24 DK101828
Pays : United States
Organisme : NIDDK NIH HHS
ID : F32 DK109662
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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