Frailty and early hospital readmission after kidney transplantation

Research output: Contribution to journalArticle

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. In a prospective longitudinal cohort study of kidney transplant recipients, the authors find that frailty was a strong predictor of hospital readmission within 30 days of transplantation, improving risk prediction above and beyond registry-based predictors.

Original languageEnglish (US)
Pages (from-to)2091-2095
Number of pages5
JournalAmerican Journal of Transplantation
Volume13
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Patient Readmission
Kidney Transplantation
Registries
Ambulatory Monitoring
ROC Curve
Geriatrics
Medical Records
Longitudinal Studies
Hospitalization
Cohort Studies
Transplantation
Morbidity
Kidney
Costs and Cost Analysis

Keywords

  • Frailty
  • readmission
  • transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Frailty and early hospital readmission after kidney transplantation. / McAdams Demarco, Mara Ann; Law, A.; Salter, M. L.; Chow, E.; Grams, Morgan; Walston, Jeremy D; Segev, Dorry.

In: American Journal of Transplantation, Vol. 13, No. 8, 08.2013, p. 2091-2095.

Research output: Contribution to journalArticle

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