TY - JOUR
T1 - Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments
T2 - A prospective cohort study
AU - Thomas, Alvin G.
AU - Ruck, Jessica M.
AU - Chu, Nadia M.
AU - Agoons, Dayawa
AU - Shaffer, Ashton A.
AU - Haugen, Christine E.
AU - Swenor, Bonnielin
AU - Norman, Silas P.
AU - Garonzik-Wang, Jacqueline
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara
N1 - Publisher Copyright:
© 2020 Oxford University Press. All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background. Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes. Methods. In our prospective cohort study (June 2013-June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registryaugmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality]. Results. In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17-9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78-9.82)], physical [0.67 (95% CI 0.08-3.35)] and walking [0.50 (95% CI 0.06-3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32-7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48-2.98)], hearing [1.01 (95% CI 0.29-3.47)] and physical [1.16 (95% CI 0.34-3.94)] impairments were not. Conclusions. Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KTmonitoring.
AB - Background. Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes. Methods. In our prospective cohort study (June 2013-June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registryaugmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality]. Results. In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17-9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78-9.82)], physical [0.67 (95% CI 0.08-3.35)] and walking [0.50 (95% CI 0.06-3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32-7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48-2.98)], hearing [1.01 (95% CI 0.29-3.47)] and physical [1.16 (95% CI 0.34-3.94)] impairments were not. Conclusions. Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KTmonitoring.
KW - graft loss
KW - impairments
KW - kidney transplantation
KW - mortality
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U2 - 10.1093/ndt/gfz164
DO - 10.1093/ndt/gfz164
M3 - Article
C2 - 31411724
AN - SCOPUS:85089359078
SN - 0931-0509
VL - 35
SP - 1262
EP - 1270
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 7
ER -