Frailty and Early Hospital Readmission After Kidney Transplantation

Abstract

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry-based recipient, transplant, and center-level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with early KT outcomes, might serve as a novel, independent predictor of EHR in KT recipients of all ages. We measured frailty in 383 KT recipients at Johns Hopkins Hospital. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post-KT discharge. Frail KT recipients were much more likely to experience EHR (45.8% vs. 28.0%, P=0.005), regardless of age. After adjusting for previously described registry-based risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR=1.61, 95% CI: 1.18–2.19, P=0.002). In addition, frailty improved EHR risk prediction by improving the area under the receiver operating characteristic curve (P=0.01) as well as the net reclassification index (P=0.04). Identifying frail KT recipients for targeted outpatient monitoring and intervention may reduce EHR rates.

Association between frailty and 30-day outcomes after discharge from hospital

“…Frail patients had higher event rates than nonfrail patients (24.1% v. 13 12-4.24). The Integrated Discrimination Improvement index was statistically significant for all models that incorporated frailty in addition to age, sex and LACE score (p < 0.001 for each comparison), which indicated that there was an improvement in the ability of the model both to predict which patients will have an event and to predict which will not.…”

“…Frailty is a multidimensional syndrome of decreased reserve and resistance to stressors leading to increased vulnerability to adverse outcomes. [11][12][13][14] The 2 models of frailty most commonly used in the literature are the phenotype model (e.g., the approach proposed by Fried and colleagues, 15 which is based on 5 objective variables assessed at one point in time that do not include psychosocial and cognitive variables) and the cumulative deficit model (e.g., the Clinical Frailty Index, which is based on a mix of more than 30 variables capturing function in many domains over time). [16][17][18] Although the gold standard for frailty assessment is a comprehensive geriatric assessment by a multidisciplinary team, both the phenotype and cumulative deficit models appear reasonably accurate for identifying frailty.…”

Frailty and Cognitive Function in Incident Hemodialysis Patients

“…At enrollment, frailty was measured as defined and validated by Fried in older adults (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and by our group in ESRD and kidney transplantation (5,6,(28)(29)(30)(31). Frailty was based on five components: shrinking (selfreport of unintentional weight loss of .10 lb in the past year based on dry weight), weakness (grip strength below an established cutoff based on sex and BMI), exhaustion (self-report), low activity (kilocalories per week below an established cutoff), and slowed walking speed (walking time of 15 ft below an established cutoff by sex and height) (3).…”

Challenging Weight Gain and Obesity: An Opportunity for Dietary Management after Successful Kidney Transplantation

“…Functional status is one of the critical criteria for selecting candidates for kidney transplantation since poor functional status or frailty in ESRD patients are associated with unfavorable transplant outcomes including re-hospitalization, poor renal allograft outcomes, and decreased patient survivals [13][14][15]. From observation, ESRD patients with a good functional status tend to do well and have a short recovery period after kidney transplantation.…”