Increased mortality after kidney transplantation in mildly frail recipients

Redondo‐Pachón, Dolores; Pérez‐Sáez, María José; Arias-Cabrales, Carlos; Redondo, Dolores; Barbosa, Francesc; Cao, Higini; Collado, Sílvia; Buxeda, Anna; Burballa, Carla; Crespo, Marta; Pascual, Julio; Faura, Anna; Vera, María; Bach, Anna Sofie; Pedreira, Guillermo; Junyent, Ernestina; Folgueiras, Montserrat; Castillo, Yolanda del Carmen Moreno; Martínez, Aida Aleyda Jiménez; Fernández, Marisol; Barbero, Eva; Causadías, Rosa; Carazo, Jesús; Cecchini, L.; Marco, Ester; Valderrama, Delky Meza de; Morgado, Andrea; Gómez, Elena Muñoz; Nogués, Xavier; Rodríguez‐Mañas, Leocadio; Vázquez, Olga Castro; Muns, María Dolores; Gárriz, Miguel; Gómez, María Polo; Hurtado, Sara; López, Maite; Ribera, Laura Badenes; Guino, Margarita; Roca, Ramón; Calls, Jordi; Rovira, Alicia; Mora, Josep Ferrater; Ibrik, Omar; Liria, Florentina; Lopez, Thais Torralbo; Almirall, Jaume; Moya, Carmen; Moreno, Fátima; Arellano, Manel Ramírez de; Rubio, Sandra; Cidraque, Ignacio; Pájaro, Carlota; Garra, Núria; Galcerán, J.M.; Fenollar, Marina; Outón, Sara; Dapena, Fabiola; Jara, Josep; Garcı́a, Rosa; Manresa, Mònica

doi:10.1093/ckj/sfac159

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…The mean ages were 44 to 63 years, and the proportions of men were 53 to 71%. Physical Frailty Phenotype (PFP) was the mostly used assessment tool for frailty, which were used in eight studies [ 19 – 22 , 24 , 27 , 30 , 31 ]. Other evaluating tools for frailty were also used, such as short physical performance battery (SPPB) [ 23 ], Frailty Risk Score (FRS) [ 25 ], the Groningen Frailty Indicator (GFI) [ 26 ], the Inflammatory-Frailty Index (IFI) [ 29 ], and the new physical frailty phenotype (nPFP) [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Frailty and prognosis of patients with kidney transplantation: a meta-analysis

Zheng,

Cao,

Wang

et al. 2023

BMC Nephrol

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Background The prevalence of frailty among candidates and recipients of kidney transplantation (KT) is well-established, yet the impact of frailty on clinical outcomes following KT remains uncertain. To address this knowledge gap, we conducted a systematic meta-analysis to comprehensively assess the aforementioned relationship. Methods The present study conducted a comprehensive search of PubMed, Embase, and Cochrane Library databases to identify relevant observational studies that compared mortality risk and other clinical outcomes of KT recipients with and without frailty. Two authors independently conducted data collection, literature searching, and statistical analysis. The results were synthesized using a heterogeneity-incorporating random-effects model. Results In this meta-analysis, 6279 patients from 13 cohort studies were included, and 1435 patients (22.9%) were with frailty before KT. There were higher mortality rates among frail patients at admission, compared to those without frailty (risk ratio [RR]: 1.97, 95% confidence interval [CI]: 1.57 to 2.47, p < 0.001; I2 = 19%). Subgroup analysis suggested the association between frailty and high mortality risk after KT was consistent in studies of frailty assessed via Physical Frailty Phenotype or other methods, and in studies of follow-up duration < or ≥ 5 years. In addition, frailty was associated with higher incidence of delayed graft function (RR: 1.78, 95% CI: 1.21 to 2.61, p = 0.003; I2 = 0%), postoperative complications (RR: 1.88, 95% CI: 1.15 to 3.08, p = 0.01; I2 = 0%), and longer hospitalization (RR: 1.55, 95% CI: 1.22 to 1.97, p < 0.001; I2 = 0%). Conclusion Following KT, frail patients are at higher risks for all-cause mortality, delayed graft function, postoperative complications, and longer hospital stays.

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Section: Resultsmentioning

confidence: 99%

Frailty and prognosis of patients with kidney transplantation: a meta-analysis

Zheng,

Cao,

Wang

et al. 2023

BMC Nephrol

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“…However, a Spanish study that specifically addressed this methodological question found that the presence of even a single PFP frailty component (score 1) has an independent impact on KTR survival, a correlate of frailty, after transplantation [ 17 ]. Based on this finding, we used the original PFP criteria as in geriatrics, where a patient is considered robust/non-frail only if no PFP components are present [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians

Vankova,

Schmalz,

Andel

et al. 2024

BMC Geriatr

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Background Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). Methods This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. Results The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01–1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39–2.89). Conclusion There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.

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“…However, emerging evidence indicates that kidney recipients with even mild frailty have increased mortality. A large retrospective study of 296 kidney recipients, after conducting multivariate analysis, reported that patients identified as having only one PFP frailty criterion (mild frailty) had an increased risk of mortality post-transplantation [HR 3.52, 95% CI: 1.03-15.9, p = 0.048] [41].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Quadriceps Muscle Layer Thickness on Length of Stay of Patients Listed for Renal Transplant

Levine,

Luke,

Sener

et al. 2023

Transplantology

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Background: Quadriceps muscle layer thickness (QMLT), which is measured using ultrasound, is an emerging strategy to identify sarcopenia. Purpose: The purpose of the study was to assess whether pre-operative QMLT values are associated with a prolonged length of stay (LOS; defined as >14 days) following a renal transplant. Methods: Between March 2019 and January 2020, we performed a prospective study among patients undergoing renal transplantation. Physical Frailty scores and QMLT measurements were performed pre-operatively. The primary outcome was a greater LOS following transplant. Secondary outcomes included complications and renal function. Statistical analysis: Percentiles divided patients into two categories of QMLT (low and high). Continuous outcomes were compared using a two-sided t-test or Mann–Whitney U test, and Chi-square analysis and Fisher exact testing were used for nominal variables. Results: Of 79 patients, the frailty prevalence was 16%. Among patients with low and higher QMLTs, LOS of >14 days were 21% vs. 3% [p = 0.04], respectively. Demographically, there was a higher percentage of patients with living donors in the high- vs. low-QMLT groups (40 vs. 7%). However, in a subgroup analysis excluding living-donor recipients, the difference between groups was preserved (23% vs. 0%, p = 0.01). No differences in secondary outcomes were seen between groups. Conclusions: Low quadriceps muscle layer thickness may be associated with a prolonged length of stay for renal recipients. Further research is needed to confirm our findings.

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Increased mortality after kidney transplantation in mildly frail recipients

Cited by 10 publications

References 22 publications

Frailty and prognosis of patients with kidney transplantation: a meta-analysis

Frailty and prognosis of patients with kidney transplantation: a meta-analysis

Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians

The Impact of Quadriceps Muscle Layer Thickness on Length of Stay of Patients Listed for Renal Transplant

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