TY - JOUR
T1 - Dynamic Frailty before Kidney Transplantation
T2 - Time of Measurement Matters
AU - Chu, Nadia M.
AU - Deng, Arlinda
AU - Ying, Hao
AU - Haugen, Christine E.
AU - Garonzik Wang, Jacqueline M.
AU - Segev, Dorry L.
AU - McAdams-Demarco, Mara A.
N1 - Funding Information:
2Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. N.M.C. and A.D. contributed equally to this article. The authors declare no conflicts of interest. This study was supported by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) grants: K24DK101828 to D.L.S. (principal investigator [PI]) and K23DK115908 to J.M.G.W. (PI), as well as the National Institute on Aging (NIA) grants F32AG053025 to C.E.H. (PI), R01AG042504 to D.L.S. (PI), K01AG043501 to M.A.M.-D. (PI), and R01AG055781 to M.A.M.-D. M.A.M.-D. was also supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334).
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background. Frail kidney transplant (KT) recipients have higher risk of adverse post-KT outcomes. Yet, there is interest in measuring frailty at KT evaluation and then using this information for post-KT risk stratification. Given long wait times for KT, frailty may improve or worsen between evaluation and KT. Patterns, predictors, and post-KT adverse outcomes associated with these changes are unclear. Methods. Five hundred sixty-nine adult KT candidates were enrolled in a cohort study of frailty (November 2009-September 2017) at evaluation and followed up at KT. Patterns of frailty transitions were categorized as follows: (1) binary state change (frail/nonfrail), (2) 3-category state change (frail/intermediate/nonfrail), and (3) raw score change (-5 to 5). Adjusted Cox proportional hazard and logistic regression models were used to test whether patterns of frailty transitions were associated with adverse post-KT outcomes. Results. Between evaluation and KT, 22.0% became more frail, while 24.4% became less frail. Black race (relative risk ratio, 1.98; 95% confidence interval [CI], 1.07-3.67) was associated with frail-To-nonfrail transition, and diabetes (relative risk ratio, 2.56; 95% CI, 1.22-5.39) was associated with remaining stably frail. Candidates who became more frail between 3-category states (hazard ratio, 2.27; 95% CI, 1.11-4.65) and frailty scores (hazard ratio, 2.36; 95% CI, 1.12-4.99) had increased risk of post-KT mortality and had higher odds of length of stay ≥2 weeks (3-category states: odds ratio, 2.02; 95% CI, 1.20-3.40; frailty scores: odds ratio, 1.92; 95% CI, 1.13-3.25). Conclusions. Almost half of KT candidates experienced change in frailty between evaluation and KT, and those transitions were associated with mortality and longer length of stay. Monitoring changes in frailty from evaluation to admission may improve post-KT risk stratification.
AB - Background. Frail kidney transplant (KT) recipients have higher risk of adverse post-KT outcomes. Yet, there is interest in measuring frailty at KT evaluation and then using this information for post-KT risk stratification. Given long wait times for KT, frailty may improve or worsen between evaluation and KT. Patterns, predictors, and post-KT adverse outcomes associated with these changes are unclear. Methods. Five hundred sixty-nine adult KT candidates were enrolled in a cohort study of frailty (November 2009-September 2017) at evaluation and followed up at KT. Patterns of frailty transitions were categorized as follows: (1) binary state change (frail/nonfrail), (2) 3-category state change (frail/intermediate/nonfrail), and (3) raw score change (-5 to 5). Adjusted Cox proportional hazard and logistic regression models were used to test whether patterns of frailty transitions were associated with adverse post-KT outcomes. Results. Between evaluation and KT, 22.0% became more frail, while 24.4% became less frail. Black race (relative risk ratio, 1.98; 95% confidence interval [CI], 1.07-3.67) was associated with frail-To-nonfrail transition, and diabetes (relative risk ratio, 2.56; 95% CI, 1.22-5.39) was associated with remaining stably frail. Candidates who became more frail between 3-category states (hazard ratio, 2.27; 95% CI, 1.11-4.65) and frailty scores (hazard ratio, 2.36; 95% CI, 1.12-4.99) had increased risk of post-KT mortality and had higher odds of length of stay ≥2 weeks (3-category states: odds ratio, 2.02; 95% CI, 1.20-3.40; frailty scores: odds ratio, 1.92; 95% CI, 1.13-3.25). Conclusions. Almost half of KT candidates experienced change in frailty between evaluation and KT, and those transitions were associated with mortality and longer length of stay. Monitoring changes in frailty from evaluation to admission may improve post-KT risk stratification.
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U2 - 10.1097/TP.0000000000002563
DO - 10.1097/TP.0000000000002563
M3 - Article
C2 - 31348438
AN - SCOPUS:85069745079
VL - 103
SP - 1700
EP - 1704
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 8
ER -