Frailty and chronic kidney disease (CKD) both increase with age and are prevalent in older adults. However, studies in older adults examining the relationship between frailty and milder impairments of kidney function are relatively sparse. We examined the crosssectional association of baseline estimated glomerular filtration rate (eGFR), albuminuria and CKD ([eGFR <60 ml/min/1.73 m 2 ] and/or albuminuria [>3.0 mg/mmol]) with prefrailty and frailty in the ASPirin in Reducing Events in the Elderly (ASPREE) trial cohort of healthy older participants. Univariate logistic regression models measured the unadjusted odds ratios (OR) and 95% confidence intervals (CI) for prevalent combined prefrailty and frailty (respectively defined as presence of 1-2 or 3+ of 5 modified fried criteria) for the association between CKD, eGFR, albuminuria and other potential risk factors. Multivariable models calculated OR for prefrailty-frailty adjusted for potential confounders and either CKD, (i) eGFR and albuminuria measured as either continuous variables; (ii) or categorical variables; (iii). Of 17 759 eligible participants, 6934 were classified as prefrail, 389 were frail. CKD, eGFR and albuminuria were all associated with combined prefrailty-frailty on univariate analysis. In the multivariable modelling, neither CKD (reduced eGFR and/or albuminuria), nor eGFR (either continuous or categorical variables) were associated with prefrailty-frailty. However, albuminuria, either as a continuous variable (OR [95% CI] 1.07 [1.04-1.10]; p < .001), or categorical variable ]; p = .001) was consistently associated with prefrailty-frailty. The complex relationship between albuminuria (which may be a biomarker for vascular inflammation), ageing, progressive CKD and frailty requires further investigation.

Background: Asplenia vaccination is employed before ABO-incompatible (ABOi) transplantation in case splenectomy is needed. Pneumococcal vaccines have been reported, in different patient groups, to increase anti-A/B titers, through cross-reactivity to shared polysaccharide epitopes. We investigated the impact of pretransplant asplenia vaccinations on anti-A/B antibody titers in prospective ABOi renal transplant recipients. Methods: Published asplenia vaccine microbial structures were reviewed to assess expression of A/B antigens. All patients who underwent ABOi transplantation at Monash Medical Centre with anti-A/B titers taken either side of asplenia vaccination were included in a retrospective cohort study between 2007 and 2021. Patients with paired titers without intervening vaccination were included as controls. Paired titers were compared within groups.Results: A and B antigens were found to be expressed by vaccine specific pneumococcal serotypes. Thirty-nine ABOi renal transplant recipients received vaccination including at least one pneumococcal vaccine. The most common donor to recipient combination was A1 to O. The median pre-and postvaccination anti-A/B titers were 1:32 and there was no significant change in titers following vaccination (median change in titer 0 dilutions, range -2 to 3, P = 0.43). The same findings were apparent in the control group (n = 20). There was no significant change in titer by donor blood group or vaccine type. No transplants were canceled or delayed by a rise in anti-A/B titers postvaccination. Conclusion: Pneumococcal vaccination had no clinically relevant impact on anti-A/B titers before ABOi transplantation in this cohort. These results provide reassurance regarding the safety of asplenia vaccination before ABOi transplantation.

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