TY - JOUR
T1 - Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients
AU - Konel, Jonathan M.
AU - Warsame, Fatima
AU - Ying, Hao
AU - Haugen, Christine E.
AU - Mountford, Alexandra
AU - Chu, Nadia M.
AU - Crews, Deidra C.
AU - Desai, Niraj M.
AU - Garonzik-Wang, Jacqueline M.
AU - Walston, Jeremy D.
AU - Norman, Silas P.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Funding Information:
This study was supported by NIH grants R01AG042504 (PI: Segev), R01AG055781 (PI: McAdams-DeMarco), R01DK114074 (PI: McAdams-DeMarco), K23DK097184 (PI: Crews), F32AG053025 (Haugen), and K24DK101828 (PI: Segev). Mara McAdams-DeMarco was also supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334) and the National Institute on Aging (K01AG043501).
Publisher Copyright:
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2018/10
Y1 - 2018/10
N2 - Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18-question Center for Epidemiologic Studies-Depression Scale (CES-D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CES-D score > 14) and frailty were associated with KT length of stay (LOS), death-censored graft failure (DCGF), and mortality. At KT admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail (aOR = 3.97, 95% CI: 2.28-6.91, P < 0.001). Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70-2.08, P < 0.001) longer LOS, 6.20-fold (95% CI:1.67-22.95, P < 0.01) increased risk of DCGF, and 2.62-fold (95% CI:1.03-6.70, P = 0.04) increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interaction < 0.001). Interventions aimed at reducing pre-KT depressive symptoms and frailty should be explored for their impact on post-KT outcomes.
AB - Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18-question Center for Epidemiologic Studies-Depression Scale (CES-D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CES-D score > 14) and frailty were associated with KT length of stay (LOS), death-censored graft failure (DCGF), and mortality. At KT admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail (aOR = 3.97, 95% CI: 2.28-6.91, P < 0.001). Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70-2.08, P < 0.001) longer LOS, 6.20-fold (95% CI:1.67-22.95, P < 0.01) increased risk of DCGF, and 2.62-fold (95% CI:1.03-6.70, P = 0.04) increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interaction < 0.001). Interventions aimed at reducing pre-KT depressive symptoms and frailty should be explored for their impact on post-KT outcomes.
KW - depressive symptoms
KW - frailty
KW - graft loss
KW - kidney transplant recipients
KW - kidney transplantation
KW - mortality
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U2 - 10.1111/ctr.13391
DO - 10.1111/ctr.13391
M3 - Article
C2 - 30152107
AN - SCOPUS:85053719396
VL - 32
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 10
M1 - e13391
ER -