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Koehler FC, Späth MR, Meyer AM, Müller RU. Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms. Curr Opin Organ Transplant 2024; 29:284-293. [PMID: 38861189 DOI: 10.1097/mot.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE OF REVIEW The role of nutrition in organ health including solid organ transplantation is broadly accepted, but robust data on nutritional regimens remains scarce calling for further investigation of specific dietary approaches at the different stages of organ transplantation. This review gives an update on the latest insights into nutritional interventions highlighting the potential of specific dietary regimens prior to transplantation aiming for organ protection and the interplay between dietary intake and gut microbiota. RECENT FINDINGS Nutrition holds the potential to optimize patients' health prior to and after surgery, it may enhance patients' ability to cope with the procedure-associated stress and it may accelerate their recovery from surgery. Nutrition helps to reduce morbidity and mortality in addition to preserve graft function. In the case of living organ donation, dietary preconditioning strategies promise novel approaches to limit ischemic organ damage during transplantation and to identify the underlying molecular mechanisms of diet-induced organ protection. Functioning gut microbiota are required to limit systemic inflammation and to generate protective metabolites such as short-chain fatty acids or hydrogen sulfide. SUMMARY Nutritional intervention is a promising therapeutic concept including the pre- and rehabilitation stage in order to improve the recipients' outcome after solid organ transplantation.
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Affiliation(s)
- Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna M Meyer
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne
- CECAD Research Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Chan GCK, Kalantar-Zadeh K, Ng JKC, Tian N, Burns A, Chow KM, Szeto CC, Li PKT. Frailty in patients on dialysis. Kidney Int 2024; 106:35-49. [PMID: 38705274 DOI: 10.1016/j.kint.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024]
Abstract
Frailty is a condition that is frequently observed among patients undergoing dialysis. Frailty is characterized by a decline in both physiological state and cognitive state, leading to a combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, and slow walking speed. Frail patients not only experience a poor quality of life, but also are at higher risk of hospitalization, infection, cardiovascular events, dialysis-associated complications, and death. Frailty occurs as a result of a combination and interaction of various medical issues in patients who are on dialysis. Unfortunately, frailty has no cure. To address frailty, a multifaceted approach is necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, and family members. Strategies such as optimizing nutrition and chronic kidney disease-related complications, reducing polypharmacy by deprescription, personalizing dialysis prescription, and considering home-based or assisted dialysis may help slow the decline of physical function over time in subjects with frailty. This review discusses the underlying causes of frailty in patients on dialysis and examines the methods and difficulties involved in managing frailty among this group.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ning Xia Medical University, Yin Chuan, China
| | - Aine Burns
- Division of Nephrology, University College London, Royal Free Hospital, London, UK
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China; Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
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Nair D, Liu CK, Raslan R, McAdams-DeMarco M, Hall RK. Frailty in Kidney Disease: A Comprehensive Review to Advance Its Clinical and Research Applications. Am J Kidney Dis 2024:S0272-6386(24)00836-9. [PMID: 38906506 DOI: 10.1053/j.ajkd.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/23/2024]
Abstract
Frailty is a multi-system syndrome of decreased physiologic reserve that has been shown to strongly and independently predict morbidity and mortality. Frailty is prevalent in patients living with kidney disease and occurs earlier in individuals with kidney disease as compared to the general population. In this comprehensive review, we aim to advance the clinical and research applications of frailty in kidney disease populations. Specifically, we clarify the definition of frailty and address its common misconceptions; review the mechanisms and epidemiology of frailty in kidney disease; discuss challenges and limitations in frailty measurement; and provide updated evidence related to risk factors for frailty, its associated adverse outcomes, and interventions. We further add to the literature in this topic by highlighting potential applications of frailty measurement in care of patients with kidney disease and conclude with our recommendations for future research related to this important syndrome.
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Affiliation(s)
- Devika Nair
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension - Nashville, Tennessee; Vanderbilt Center for Health Services Research - Nashville, Tennessee; Tennessee Valley Veterans Affairs Healthcare System - Nashville, Tennessee
| | - Christine K Liu
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California; Section of Geriatric Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine - Stanford, California
| | - Rasha Raslan
- Department of Medicine, Duke University School of Medicine - Durham, North Carolina
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University Langone Health and Grossman School of Medicine - New York, New York; Department of Population Health, New York University Langone Health and Grossman School of Medicine - New York, New York
| | - Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine - Durham, North Carolina; Durham Veterans Affairs Medical Center - Durham, North Carolina.
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Pérez-Sáez MJ, Pascual J. Unmet Questions About Frailty in Kidney Transplant Candidates. Transplantation 2024:00007890-990000000-00795. [PMID: 38886883 DOI: 10.1097/tp.0000000000005093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Frailty occurs frequently among patients with advanced chronic kidney disease, especially among women. Assessing frailty in kidney transplant (KT) candidates is crucial for informing them about associated risks. However, there is poor agreement between frailty scales and research on their correlation with transplant outcomes. Being prefrail significantly impacts both graft and patient survival, often beginning with just 1 Fried criterion. Rather than viewing frailty as a categorical state, it should be regarded as a spectrum ranging from 1 to 5 criteria, with the risk of adverse outcomes escalating as frailty worsens. Frailty status fluctuates during the waiting period for KT; hence, a 1-time frailty evaluation is insufficient to determine risks and implement strategies for improving functional status. Further research should investigate the components of frailty that most frequently change during this waiting period and establish strategies to prevent or reverse frailty. Although careful evaluation of frail KT candidates is necessary to prevent early complications and mortality, exclusion based solely on a frailty score is unwarranted. Instead, efforts should focus on timely interventions to enhance their condition before transplantation. Although evidence is limited, exercise programs appear feasible and yield positive results. A pretransplant clinical framework encompassing multimodal prehabilitation-comprising physical therapy, nutritional measures, and psychological support-during the waiting list period may help alleviate the effects of frailty and poor fitness after KT, ultimately improving key outcomes. Despite logistical challenges, there is a pressing need for interventional trials in this area.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Institute for Research i+12, Madrid, Spain
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Quint EE, Pol RA, Segev DL, McAdams-DeMarco MA. Age Is Just a Number for Older Kidney Transplant Patients. Transplantation 2024:00007890-990000000-00760. [PMID: 38771060 DOI: 10.1097/tp.0000000000005073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The rise in the mean age of the global population has led to an increase in older kidney transplant (KT) patients. This demographic shift, coupled with the ongoing organ shortage, requires a nuanced understanding of which older adults are most suitable for KT. Recognizing the increased heterogeneity among older adults and the limitations of solely relying on chronological age, there is a need to explore alternative aging metrics beyond chronological age. In this review, we discuss the impact of older age on access to KT and postoperative outcomes. Emphasizing the need for a comprehensive evaluation that extends beyond chronological age, we explore alternative aging metrics such as frailty, sarcopenia, and cognitive function, underscoring their potential role in enhancing the KT evaluation process. Most importantly, we aim to contribute to the ongoing discourse, fostering an optimized approach to KT for the rapidly growing population of older adults.
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Affiliation(s)
- Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Vankova H, Schmalz M, Andel R, Rajnochova Bloudickova S. Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians. BMC Geriatr 2024; 24:423. [PMID: 38741066 DOI: 10.1186/s12877-024-04972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
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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Affiliation(s)
- Hana Vankova
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic.
| | - Michal Schmalz
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Chanan EL, Wagener G, Whitlock EL, Berger JC, McAdams-DeMarco MA, Yeh JS, Nunnally ME. Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review. Transplantation 2024:00007890-990000000-00716. [PMID: 38557579 DOI: 10.1097/tp.0000000000005000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65 y face when they undergo kidney or liver transplantation. We focus on geriatric syndromes that are common in older patients listed for kidney or liver transplantation including frailty, sarcopenia, and cognitive dysfunction; discuss important considerations for older transplant recipients, which may impact preoperative risk stratification; and describe unique challenges in intraoperative and postoperative management for older patients. Intraoperative challenges in the older adult include using evidence-based best anesthetic practices, maintaining adequate perfusion pressure, and using minimally invasive surgical techniques. Postoperative concerns include controlling acute postoperative pain; preventing cardiovascular complications and delirium; optimizing immunosuppression; preventing perioperative kidney injury; and avoiding nephrotoxicity and rehabilitation. Future studies are needed throughout the perioperative period to identify interventions that will improve patients' preoperative physiologic status, prevent postoperative medical complications, and improve medical and patient-centered outcomes in this vulnerable patient population.
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Affiliation(s)
- Emily L Chanan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Jonathan C Berger
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Joseph S Yeh
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
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Chen Y, Churilla B, Ahn JB, Quint EE, Sandal S, Musunuru A, Pol RA, Hladek MD, Crews DC, Segev DL, McAdams-DeMarco M. Age Disparities in Access to First and Repeat Kidney Transplantation. Transplantation 2024; 108:845-853. [PMID: 37525348 PMCID: PMC10830888 DOI: 10.1097/tp.0000000000004747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Evidence suggests that older patients are less frequently placed on the waiting list for kidney transplantation (KT) than their younger counterparts. The trends and magnitude of this age disparity in access to first KT and repeat KT (re-KT) remain unclear. METHODS Using the US Renal Data System, we identified 2 496 743 adult transplant-naive dialysis patients and 110 338 adult recipients with graft failure between 1995 and 2018. We characterized the secular trends of age disparities and used Cox proportional hazard models to compare the chances of listing and receiving first KT versus re-KT by age (18-64 y versus ≥65 y). RESULTS Older transplant-naive dialysis patients were less likely to be listed (adjusted hazard ratio [aHR] = 0.18; 95% confidence interval [CI], 0.17-0.18) and receive first KT (aHR = 0.88; 95% CI, 0.87-0.89) compared with their younger counterparts. Additionally, older patients with graft failure had a lower chance of being listed (aHR = 0.40; 95% CI, 0.38-0.41) and receiving re-KT (aHR = 0.76; 95% CI, 0.72-0.81). The magnitude of the age disparity in being listed for first KT was greater than that for re-KT ( Pinteraction < 0.001), and there were no differences in the age disparities in receiving first KT or re-KT ( Pinteraction = 0.13). Between 1995 and 2018, the age disparity in listing for first KT reduced significantly ( P < 0.001), but the age disparities in re-KT remained the same ( P = 0.16). CONCLUSIONS Age disparities exist in access to both first KT and re-KT; however, some of this disparity is attenuated among older adults with graft failure. As the proportion of older patients with graft failure rises, a better understanding of factors that preclude their candidacy and identification of appropriate older patients are needed.
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Affiliation(s)
- Yusi Chen
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Bryce Churilla
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - JiYoon B. Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evelien E. Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amrusha Musunuru
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Robert A. Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Mara McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
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Fisher MC, Chen X, Crews DC, DeGroot L, Eneanya ND, Ghildayal N, Gold M, Liu Y, Sanders JJ, Scherer JS, Segev DL, McAdams-DeMarco MA. Advance Care Planning and Palliative Care Consultation in Kidney Transplantation. Am J Kidney Dis 2024; 83:318-328. [PMID: 37734687 PMCID: PMC10922230 DOI: 10.1053/j.ajkd.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 09/23/2023]
Abstract
RATIONALE & OBJECTIVE Because of the high risk of waitlist mortality and posttransplant complications, kidney transplant (KT) patients may benefit from advance care planning (ACP) and palliative care consultation (PCC). We quantified the prevalence and racial disparities in ACP and PCC among KT candidates and recipients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,575 adult KT candidates and 1,233 adult recipients (2008-2020). EXPOSURE Race and ethnicity. OUTCOMES All reports of ACP and PCC were abstracted from chart review. ACP was defined as patient self-report of an advance directive, presence of an advance directive in the medical record, or a documented goals-of-care conversation with a provider. PCC was defined as an ordered referral or a documented palliative care note in the medical record. ANALYTICAL APPROACH Racial/ethnic disparities in ACP/PCC were estimated using adjusted logistic regression. RESULTS 21.4% of KT candidates and 34.9% of recipients engaged in ACP. There were racial/ethnic disparities in ACP among KT candidates (White, 24.4%; Black, 19.1%; Hispanic, 15%; other race and ethnicity, 21.1%; P=0.008) and recipients (White, 39.5%; Black, 31.2%; Hispanic, 26.3%; other race and ethnicity, 26.6%; P=0.007). After adjustment, Black KT recipients had a 29% lower likelihood of engaging in ACP (OR, 0.71; 95% CI, 0.55-0.91) than White KT recipients. Among older (aged≥65 years) recipients, those who were Black had a lower likelihood of engaging in ACP, but there was no racial disparity among younger recipients (P=0.020 for interaction). 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC; there were no racial disparities in PCC among KT candidates (White, 5.3%; Black, 3.6%; Hispanic, 2.5%; other race and ethnicity, 2.1%; P=0.13) or recipients (White, 5.5%; Black, 5.6%; Hispanic, 0.0%; other race and ethnicity, 1.3%; P = 0.21). LIMITATIONS Generalizability may be limited to academic transplant centers. CONCLUSIONS ACP is not common among KT patients, and minoritized transplant patients are least likely to engage in ACP; PCC is less common. Future efforts should aim to integrate ACP and PCC into the KT process. PLAIN-LANGUAGE SUMMARY Kidney transplant (KT) candidates and recipients are at elevated risk of morbidity and mortality. They may benefit from completing a document or conversation with their palliative care provider that outlines their future health care wishes, known as advance care planning (ACP), which is a component of palliative care consultation (PCC). We wanted to determine how many KT candidates and recipients have engaged in ACP or PCC and identify potential racial disparities. We found that 21.4% of candidates and 34.9% of recipients engaged in ACP. After adjustment, Black recipients had a 29% lower likelihood of engaging in ACP. We found that 4.2% of KT candidates and 5.1% of KT recipients engaged in PCC, with no racial disparities found in PCC.
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Affiliation(s)
- Marlena C Fisher
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lyndsay DeGroot
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nwamaka D Eneanya
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nidhi Ghildayal
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Marshall Gold
- Johns Hopkins School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yi Liu
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York
| | - Justin J Sanders
- Department of Family Medicine, Palliative Care McGill, McGill University, Montreal, QC, Canada
| | - Jennifer S Scherer
- Department of Medicine, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, NY.
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10
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Lin K, Fang J, Zhang S, Ding Z, Hu Y, Zhang B, Guo X, Liu H, Zhao P. Baduanjin exercise intervention trial: research protocol of a randomised controlled trial for frail kidney transplant recipients. BMJ Open 2024; 14:e074717. [PMID: 38199632 PMCID: PMC10806679 DOI: 10.1136/bmjopen-2023-074717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Frailty is one of the most common comorbidities in kidney transplant recipients (KTRs). Physical, psychological and social frailty could be improved by exercise intervention. Baduanjin, also known as Eight-section Brocades, is a type of traditional Chinese medicine exercise characterised by the interplay between physical postures and movements, breathing and mind. It can help frail patients strengthen their upper and lower body muscles, improve their mood, quality of life and frailty. However, the effectiveness of Baduanjin on frail KTRs remains unknown. Therefore, we will conduct a randomised controlled trial (RCT) to evaluate the effectiveness of Baduanjin on frail KTRs. METHODS AND ANALYSIS This protocol describes an assessor and analyst blinded, parallel RCT for frail KTRs comparing Baduanjin group (n=72) with care-as-usual group (n=72). The primary outcomes are frailty assessed by Frailty Phenotype scale and Tilburg Frailty Indicator scale, and muscle strength assessed by a grip strength metre. The secondary outcomes are quality of life assessed by Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) and depression assessed by the Hospital Anxiety and Depression Scale. All these data will be collected at the baseline, after 3, 6, 9 and 12 months, respectively. Two-way mixed analysis of variance (ANOVA) will be used to test the effectiveness of Baduanjin exercise. Qualitative interviews with participants in the intervention group will also be performed after 6 months. Themes will be extracted from interview transcripts using NVivo software. ETHICS AND DISSEMINATION The Ethics Committees of Beijing University of Chinese Medicine (2022BZYLL1018) and China-Japan Friendship Hospital (2022-KY-250) had approved the study. The organ donors were all from China-Japan Friendship Hospital. They provided informed consent and they were not executed prisoners. We have provided BMJ Open with documentation from the hospital that indicates that the organs will be harvested ethically. The findings of this study will be disseminated through peer-reviewed journals, international conferences, media reports and briefings. TRIAL REGISTRATION NUMBER ChiCTR2100041730.
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Affiliation(s)
- Keke Lin
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxin Fang
- Beijing University of Chinese Medicine, Beijing, China
| | - Shuping Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Yanbin Hu
- Beijing University of Chinese Medicine, Beijing, China
| | - Bei Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Xuejie Guo
- China-Japan Friendship Hospital, Beijing, China
| | - Hongxia Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Peiyu Zhao
- China-Japan Friendship Hospital, Beijing, China
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Mallick S, Sakowitz S, Bakhtiyar SS, Chervu N, Valenzuela A, Kim S, Benharash P. Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation. Clin Transplant 2024; 38:e15200. [PMID: 38041448 DOI: 10.1111/ctr.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post-transplant outcomes following kidney transplantation (KT) are lacking. METHODS This was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. RESULTS Of an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in-hospital mortality (AOR 2.17, 95% CI: 1.33-3.57) compared to their non-frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non-frail counterparts. Frailty was also associated with greater adjusted risk of non-home discharge. CONCLUSIONS Frailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post-transplantation care of the growing frail cohort undergoing KT.
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Affiliation(s)
- Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alberto Valenzuela
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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12
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Weerasekera S, Reid N, Young A, Homes R, Sia A, Giddens F, Francis RS, Hubbard RE, Gordon EH. Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients? Transplant Direct 2023; 9:e1548. [PMID: 37854024 PMCID: PMC10581598 DOI: 10.1097/txd.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Background Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment. Methods A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis. Results The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors. Conclusions The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.
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Affiliation(s)
- Shavini Weerasekera
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Adrienne Young
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ryan Homes
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Aaron Sia
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Fiona Giddens
- Department of Nephrology, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Ross S. Francis
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Ruth E. Hubbard
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emily H. Gordon
- Geriatrics and Rehabilitation Unit, Princess Alexandra Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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13
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Zheng J, Cao Y, Wang Z, Nian Y, Guo L, Song W. Frailty and prognosis of patients with kidney transplantation: a meta-analysis. BMC Nephrol 2023; 24:303. [PMID: 37833650 PMCID: PMC10576274 DOI: 10.1186/s12882-023-03358-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
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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Affiliation(s)
- Jianming Zheng
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China
| | - Yu Cao
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China
| | - Zhen Wang
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China
| | - Yeqi Nian
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China
| | - Liping Guo
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China
| | - Wenli Song
- Department of Kidney and Pancreas Transplantation, Tianjin First Central Hospital, Nankai District, Tianjin, 300192, China.
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Pedreira‐Robles G, Garcimartín P, Bach‐Pascual A, Giró‐Formatger D, Redondo‐Pachón D, Morín‐Fraile V. Creating the nursing care map in the evaluation of kidney transplant candidates: A scoping review and narrative synthesis. Nurs Open 2023; 10:6668-6689. [PMID: 37480193 PMCID: PMC10495730 DOI: 10.1002/nop2.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/21/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
AIMS To analyse the aspects involved in the care of individuals assessed as kidney transplant candidates and to identify the role of nurses in providing specialised care for this population. DESIGN Scoping review. The results were summarised using a narrative synthesis technique. DATA SOURCES A review of the literature published between 2001 and 2021 was conducted between October and November 2021 using PubMed, CINAHL and SciELO. REVIEW METHODS The research team agreed on a search strategy based on clinical practice guidelines for assessing kidney transplantation candidates. Quantitative, qualitative and mixed methods studies published in peer-reviewed journals in English, Spanish, French and Portuguese were included. RESULTS A total of 377 studies were identified, and 49 articles were included after the inclusion and exclusion criteria were applied. The narrative synthesis was structured into four themes: Physical needs; Psychological and quality of life needs; Education and adherence needs; and Nurses' role. CONCLUSION Nursing assessment of kidney transplantation candidates should encompass physical, psychosocial and adherence aspects. A variety of methodologies and resources are available for this assessment. Nurses contribute to coordinating access to kidney transplantation, aiming to improve adherence to an appropriate lifestyle to prevent patients from being excluded from kidney transplantation or suffering from kidney transplantation-related complications. IMPACT Based on our findings, we managed to design a nursing care map for kidney transplantation candidates combining the main elements of nursing care that should be incorporated into this process. Advanced practice nursing professionals play a crucial role in accessing renal transplant care.
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Affiliation(s)
- Guillermo Pedreira‐Robles
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- ESIMar (Mar Nursing School)Parc de Salut Mar, Universitat Pompeu Fabra affiliatedBarcelonaSpain
- SDHEd (Social Determinants and Health Education Research Group)IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Nursing and Health PhD ProgramUniversity of BarcelonaBarcelonaSpain
| | - Paloma Garcimartín
- Nursing DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- Research Group in Nursing CareIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Biomedical Network Research Center for Cardiovascular DiseasesCIBERCV, Carlos III Health InstituteMadridSpain
| | - Anna Bach‐Pascual
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
| | - Dolors Giró‐Formatger
- Nursing Care Methodology and Quality departmentHospital del Mar, Parc de Salut MarBarcelonaSpain
| | - Dolores Redondo‐Pachón
- Nephrology DepartmentHospital del Mar, Parc de Salut MarBarcelonaSpain
- Kidney Research Group (GREN)Hospital del Mar Institute for Medical Research (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN)BarcelonaSpain
| | - Victoria Morín‐Fraile
- Department of Public Health, Mental and Maternal and Child Health, Nursing schoolUniversity of BarcelonaBarcelonaSpain
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15
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Zhang F, Wang H, Bai Y, Zhang Y, Huang L, Zhang H. Prevalence of physical frailty and impact on survival in patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2023; 24:258. [PMID: 37661257 PMCID: PMC10476333 DOI: 10.1186/s12882-023-03303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Frailty is common in chronic kidney disease (CKD) patients and becomes more prevalent as kidney disease progresses. This study aimed to investigate the prevalence of physical frailty and quantify the relationship between frailty and mortality risk in patients with CKD. METHODS PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrial.gov, and major renal academic conferences were systematically searched, and additional references to relevant articles were manually searched. The prevalence of physical frailty and the risk of mortality based on random-effects models were assessed using percentages and hazard ratio (HR) with a 95% confidence interval (CI). RESULTS A total of 139 articles, including 1,675,482 participants, met the eligibility criteria for the meta-analysis. The results showed that 34.5% (95% CI 31.0 to 38.1%) of CKD patients showed signs of frailty, and 39.4% (95% CI 35.4 to 43.5%) had prefrail symptoms. Compared to non-frail patients, the risk of mortality was increased by 94.1% (95% CI 1.586 to 2.375) in frail patients and 34.5% (95% CI 1.231 to 1.469) in prefrail patients. CONCLUSION The high prevalence of frailty and prefrail in adults with CKD and resulting in premature death emphasize the importance of measuring frailty, which provides important prognostic information and may provide opportunities for interventions to improve the prognosis of patients with CKD.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Zhang
- Department of Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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16
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Kosoku A, Iwai T, Kabei K, Nishide S, Machida Y, Uchida J. Frailty and sarcopenia in older kidney transplant recipients: a cross-sectional study. Eur Geriatr Med 2023; 14:861-868. [PMID: 37219724 DOI: 10.1007/s41999-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE The aging of the kidney transplant population is accelerating, and measures against geriatric syndromes including frailty and sarcopenia, which elevate the risk of needing long-term care and even death, are being considered important. Recently, both the frailty and sarcopenia criteria for Asians were revised based on various research reports and clinical experiences. The purpose of this study is twofold: firstly, to investigate the prevalence of frailty based on the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria and the Kihon Checklist (KCL) and that of sarcopenia based on the Asian Working Group for Sarcopenia (AWGS) 2019 as well as the relationship between frailty and sarcopenia, and secondly, to determine the concurrent validity of the KCL with the revised J-CHScriteria in older kidney transplant recipients. METHODS This study was a single-center cross-sectional investigation carried out on older kidney transplant recipients who visited our hospital from August 2017 to February 2019. The diagnosis of frailty was assessed using the revised J-CHS criteria and the KCL. The diagnosis of sarcopenia was made by low skeletal muscle mass and either low physical performance or low muscle strength based on the AWGS 2019. To examine the relationship between frailty and sarcopenia, categorical variables were compared using chi-squared test and continuous variables Mann-Whitney U test. Spearman's correlation analysis was used to investigate the correlation between the KCL score and the revised J-CHS score. The concurrent validity of the KCL for estimating frailty based on the revised J-CHS criteria was evaluated using the receiver operating characteristics (ROC) curve analysis. RESULTS A total of 100 older kidney transplant recipients were enrolled in this study. The median age was 67, 63 (63%) were males, and the median time after transplant was 95 months. The prevalence of frailty based on the revised J-CHS criteria and the KCL, and sarcopenia based on the AWGS 2019 was 15%, and 19%, and 16% respectively. Sarcopenia was significantly associated with frailty based on the KCL (p = 0.016), while not with frailty based on the revised J-CHS criteria (p = 0.11). The KCL score significantly correlated with the revised J-CHS score (p < 0.001). The area under the ROC curve was 0.91. CONCLUSION Frailty and sarcopenia are interrelated complex geriatric syndromes that are risk factors for adverse health outcomes. In older kidney transplant recipients, frailty and sarcopenia were highly prevalent and frequently co-existed. Furthermore, the KCL was verified as a useful tool for frailty screening in these patient. Easy identification of patients with frailty, which is reversible, can help clinicians institute appropriate corrective measures for kidney transplant recipients to improve transplant outcomes.
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Affiliation(s)
- Akihiro Kosoku
- Department of Urology, Meijibashi Hospital, 1-358-3, Miyakenishi, Matsubara, 580-0045, Japan.
- Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Shunji Nishide
- Department of Urology, Osaka City General Hospital, 2-13-22, Miyakojima-Hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yuichi Machida
- Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
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17
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Quint EE, Haanstra AJ, van der Veen Y, Maring H, Berger SP, Ranchor A, Bakker SJL, Finnema E, Pol RA, Annema C. PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study: protocol for a hybrid type I, mixed method, randomised controlled trial. BMJ Open 2023; 13:e072805. [PMID: 37500274 PMCID: PMC10387712 DOI: 10.1136/bmjopen-2023-072805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Kidney transplant candidates (KTCs) need to be in optimal physical and psychological condition prior to surgery. However, KTCs often experience compromised functional capacity which can be characterised as frailty. Prehabilitation, the enhancement of a person's functional capacity, may be an effective intervention to improve the health status of KTCs. The PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study aims to examine the effectiveness of a multimodal prehabilitation programme on the health status of KTCs, and to explore the potential of implementation of prehabilitation in daily clinical practice. METHODS AND ANALYSIS This study uses a single centre, effectiveness-implementation hybrid type I study design, comprised of a randomised controlled trial and a mixed-methods study. Adult patients who are currently on the transplant waiting list or are waitlisted during the study period, at a university medical centre in The Netherlands, will be randomly assigned to either prehabilitation (n=64) or care as usual (n=64) groups. The prehabilitation group will undergo a 12-week home-based, tailored prehabilitation programme consisting of physical and/or nutritional and/or psychosocial interventions depending on the participant's deficits. This programme will be followed by a 12-week maintenance programme in order to enhance the incorporation of the interventions into daily life. The primary endpoint of this study is a change in frailty status as a proxy for health status. Secondary endpoints include changes in physical fitness, nutritional status, psychological well-being, quality of life and clinical outcomes. Tertiary endpoints include the safety, feasibility and acceptability of the prehabilitation programme, and the barriers and facilitators for further implementation. ETHICS AND DISSEMINATION Medical ethical approval was granted by the Medical Ethics Committee Groningen, Netherlands (M22.421). Written informed consent will be obtained from all participants. The results will be disseminated at international conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT05489432.
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Affiliation(s)
- Evelien E Quint
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Avril J Haanstra
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne van der Veen
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Internal Medicine, Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heleen Maring
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Physical Therapy, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Internal Medicine, Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adelita Ranchor
- Department of Health Sciences, Section of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Internal Medicine, Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelyn Finnema
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lieber SB, Nahid M, Navarro-Millán I, Rajan M, Sattui SE, Mandl LA. Frailty and emergency department utilisation in adults with systemic lupus erythematosus ≤65 years of age: an administrative claims data analysis of Medicaid beneficiaries. Lupus Sci Med 2023; 10:e000905. [PMID: 37524516 PMCID: PMC10391790 DOI: 10.1136/lupus-2023-000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Frailty is a risk factor for adverse health in adults with SLE, including those <65 years. Emergency department (ED) utilisation is high in adults with SLE, but to our knowledge, whether frailty is associated with ED use is unknown. In a large administrative claims dataset, we assessed risk of ED utilisation among frail adults with SLE ≤65 years of age relative to non-frail adults ≤65 years of age with SLE. METHODS Using the MarketScan Medicaid subset from 2011 to 2015, we identified beneficiaries 18-65 years with SLE (≥3 SLE International Classification of Diseases, Ninth Revision codes ≥30 days apart). Comparators without a systemic rheumatic disease (SRD) were matched 4:1 on age and gender. Frailty status in 2011 was determined using two claims-based frailty indices (CFIs). We compared risk of recurrent ED utilisation among frail and non-frail beneficiaries with SLE using an extension of the Cox proportional hazard model for recurrent events data. RESULTS Of 2262 beneficiaries with SLE and 9048 non-SRD comparators, 28.8% and 11.6% were frail, respectively, according to both CFIs. Compared with non-frail beneficiaries with SLE, frail beneficiaries with SLE had significantly higher hazard of recurrent ED use (HR 1.75, 95% CI 1.48 to 2.08). CONCLUSION Frailty increased hazard of recurrent ED visits in frail adults ≤65 years of age with SLE relative to comparable non-frail adults with SLE. Frailty is a potential target for efforts to improve quality of care in SLE.
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Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Musarrat Nahid
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Iris Navarro-Millán
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Mangala Rajan
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Sebastian E Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
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Artiles A, Domínguez A, Subiela JD, Boissier R, Campi R, Prudhomme T, Pecoraro A, Breda A, Burgos FJ, Territo A, Hevia V. Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 51:13-25. [PMID: 37006961 PMCID: PMC10064232 DOI: 10.1016/j.euros.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 04/04/2023] Open
Abstract
Context Owing to population ageing, a growing number of kidney transplants (KTs) in elderly population are being performed. KT is the best treatment for patients with end-stage renal disease (ESRD). However, in older patients, the decision between dialysis and KT can be difficult due to potential inferior outcomes. Few studies have been published addressing this issue, and literature outcomes are controversial. Objective To conduct a systematic review and meta-analysis to appraise the evidence about outcomes of KT in elderly patients (>70 yr). Evidence acquisition A systematic review and meta-analysis (PROSPERO registration: CRD42022337038) was performed. Search was conducted on PubMed and LILACS databases. Comparative and noncomparative studies addressing outcomes (overall survival [OS], graft survival [GS], complications, delayed graft function [DGF], primary nonfunction, graft loss, estimated glomerular filtrate rate, or acute rejection) of KT in people older than 70 yr were included. Evidence synthesis Of the 10 357 yielded articles, 19 met the inclusion criteria (18 observational studies, one prospective multicentre study, and no randomised controlled trials), enrolling a total of 293 501 KT patients. Comparative studies reporting enough quantitative data for target outcomes were combined. There were significant inferior 5-yr OS (relative risk [RR], 1.66; 95% confidence interval [CI], 1.18-2.35) and 5-yr GS in the elderly group (RR, 1.37; 95% CI, 1.14-1.65) to those in the <70-yr group. Short-term GS at 1 and 3 yr was similar between groups, and similar findings occurred with DGF, graft loss, and acute rejection rates. Few data about postoperative complications were reported. Conclusions Elderly recipients have worse OS at all time points and long-term GS compared with younger recipients (<70 yr). Postoperative complications were under-reported and could not be assessed. The DGF, acute rejection, death with functioning graft, and graft loss were not inferior in elderly recipients. Geriatric assessment in this setting might be useful for selecting better elderly candidates for KT. Patient summary Compared with younger population, kidney transplant in elderly patients has inferior patient and graft survival outcomes in the long term.
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Affiliation(s)
- Alberto Artiles
- Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - Ana Domínguez
- Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - José Daniel Subiela
- Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - Romain Boissier
- Aix-Marseille University, Marseille, France
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Thommas Prudhomme
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alberto Breda
- Urology Department, Fundación Puigvert, University Autónoma of Barcelona, Barcelona, Spain
| | - Francisco Javier Burgos
- Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - Angelo Territo
- Urology Department, Fundación Puigvert, University Autónoma of Barcelona, Barcelona, Spain
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
- Corresponding author. Urology, Ctra Colmenar km 9,100, Madrid 28034, Spain. Tel. +34 645 946 800; Fax: +34 913 368 760.
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20
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McAdams-DeMarco MA, Thind AK, Nixon AC, Woywodt A. Frailty assessment as part of transplant listing: yes, no or maybe? Clin Kidney J 2023; 16:809-816. [PMID: 37151416 PMCID: PMC10157764 DOI: 10.1093/ckj/sfac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 12/31/2022] Open
Abstract
Frailty, characterized by a decreased physiological reserve and an increased vulnerability to stressors, is common among kidney transplant (KT) candidates and recipients. In this review, we present and summarize the key arguments for and against the assessment of frailty as part of KT evaluation. The key arguments for including frailty were: (i) sheer prevalence and far-reaching consequences of frailty on KT, and (ii) the ability to conduct a more holistic and objective evaluation of candidates, removing the inaccuracy associated with 'eye-ball' assessments of transplant fitness. The key argument against were: (i) lack of agreement on the definition of frailty and which tools should be used in renal populations, (ii) a lack of clarity on how, by whom and how often frailty assessments should be performed, and (iii) a poor understanding of how acute stressors affect frailty. However, it is the overwhelming opinion that the time has come for frailty assessments to be incorporated into KT listing. Although ongoing areas of uncertainty exist and further evidence development is needed, the well-established impact of frailty on clinical and experiential outcomes, the invaluable information obtained from frailty assessments, and the potential for intervention outweigh these limitations. Proactive and early identification of frailty allows for individualized and improved risk assessment, communication and optimization of candidates.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Amarpreet K Thind
- Division of Immunology and Inflammation, Department of Medicine, Centre for Inflammatory Disease, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Manchester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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21
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Chan GCK, Fung WWS, Szeto CC, Ng JKC. From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis. Nephrology (Carlton) 2023; 28:215-226. [PMID: 36807408 DOI: 10.1111/nep.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient-oriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winston Wing-Shing Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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22
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Fleetwood VA, Caliskan Y, Rub FAA, Axelrod D, Lentine KL. Maximizing opportunities for kidney transplantation in older adults. Curr Opin Nephrol Hypertens 2023; 32:204-211. [PMID: 36633323 DOI: 10.1097/mnh.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To summarize the current state of evidence related to the outcomes of older adults who need and receive kidney transplants, and strategies to facilitate appropriate transplant access in this at-risk group. RECENT FINDINGS Older adults are a rapidly growing subgroup of the kidney transplant waitlist. Compared to younger adults, older kidney transplant recipients have increased mortality after kidney transplant and lower death-censored graft survival. In determining suitability for transplantation in older patients, clinicians must balance procedural and immunosuppression-related risk with incremental survival when compared with dialysis. To appropriately increase access to transplantation in this population, clinicians and policy makers consider candidates' chronological age and frailty, as well as the quality of and waiting time for a donated allograft. Given risk of deterioration prior to transplant, candidates should be rapidly evaluated, listed, and transplanted using living donor and or less than ideal deceased donor organs when available. SUMMARY Access to transplantation for older adults can be increased through targeted interventions to address frailty and reduce waiting times through optimized organ use. Focused study and educational interventions for patients and providers are needed to improve the outcomes of this vulnerable group.
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Affiliation(s)
- Vidya A Fleetwood
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Fadee Abu Al Rub
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | | | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
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23
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Quint EE, Ferreira M, van Munster BC, Nieuwenhuijs-Moeke G, te Velde-Keyzer C, Bakker SJL, Annema C, Mathur S, Pol RA. Prehabilitation in Adult Solid Organ Transplant Candidates. CURRENT TRANSPLANTATION REPORTS 2023; 10:70-82. [PMID: 37124070 PMCID: PMC10039771 DOI: 10.1007/s40472-023-00395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/02/2023]
Abstract
Purpose of Review To highlight the importance of biological age in the context of prehabilitation and to present relevant research regarding prehabilitation prior to solid organ transplantation. Recent Findings Studies on the effect of prehabilitation have been performed in kidney-, lung-, liver-, and heart transplant patient populations. Prior to kidney transplantation, exercise interventions have been shown to improve cardiopulmonary- and physical fitness and result in a decreased length of hospital stay postoperatively. Among lung transplant candidates, various methods of prehabilitation have been studied including home-based, outpatient and in-patient programs, consisting of physical training, psychological support, education, and nutritional interventions. Overall, prehabilitation seems to improve or maintain quality of life and exercise capacity in this patient population. Patients undergoing liver transplantation seem to benefit from prehabilitation as well. Not only does it seem safe and feasible, but significant improvements in aerobic and functional capacity have also been found. Regarding heart transplant candidates, both inpatient and outpatient, supervised prehabilitation programs show promising results with improvements in exercise capacities and quality of life. Summary Prehabilitation is an effective and safe intervention for improving functional outcomes of solid organ transplant patients. Future studies should evaluate whether prehabilitation translates into improved pre- and post-transplant clinical outcomes.
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Affiliation(s)
- Evelien E. Quint
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Manoela Ferreira
- Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Barbara C. van Munster
- Division of Geriatric Medicine, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gertrude Nieuwenhuijs-Moeke
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotte te Velde-Keyzer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Coby Annema
- Division of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston Ontario, Canada
| | - Robert A. Pol
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
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Dos Santos Mantovani M, Coelho de Carvalho N, Ferreira Minicucci M, Gustavo Modelli de Andrade L, de Souza Cavalcante R, Berg de Almeida G, Aline Costa N, de Fátima da Silva J, Augusto Monteiro de Barros Almeida R. Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study. J Nephrol 2022; 35:2341-2349. [PMID: 36048368 DOI: 10.1007/s40620-022-01436-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx. METHODS In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods. RESULTS Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001). CONCLUSIONS There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.
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Affiliation(s)
| | | | - Marcos Ferreira Minicucci
- Internal Medicine Department, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | | | - Ricardo de Souza Cavalcante
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Gabriel Berg de Almeida
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Nara Aline Costa
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Julhiany de Fátima da Silva
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
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25
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Alfieri C, Malvica S, Cesari M, Vettoretti S, Benedetti M, Cicero E, Miglio R, Caldiroli L, Perna A, Cervesato A, Castellano G. Frailty in kidney transplantation: a review on its evaluation, variation and long-term impact. Clin Kidney J 2022; 15:2020-2026. [PMID: 36325001 PMCID: PMC9613431 DOI: 10.1093/ckj/sfac149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 10/15/2023] Open
Abstract
The problem of frailty in kidney transplantation is an increasingly discussed topic in the transplant field, partially also generated by the multiple comorbidities by which these patients are affected. The criteria currently used to establish the presence and degree of frailty can be rapidly assessed in clinical practice, even in patients with chronic kidney disease (CKD). The main objectives of this work are: (i) to describe the method of evaluation and the impact that frailty has in patients affected by CKD, (ii) to explore how frailty should be studied in the pre-transplant evaluation, (iii) how frailty changes after a transplant and (iv) the impact frailty has over the long term on the survival of renal transplant patients.
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Affiliation(s)
- Carlo Alfieri
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Malvica
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Simone Vettoretti
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Matteo Benedetti
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Elisa Cicero
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Roberta Miglio
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Lara Caldiroli
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
| | - Alessandro Perna
- Department of Translational Medical Sciences, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Angela Cervesato
- Department of Translational Medical Sciences, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Giuseppe Castellano
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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26
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Thind AK, Rule A, Goodall D, Levy S, Brice S, Dor FJMF, Evans N, Ospalla D, Thomas N, Wellsted D, Johansson L, Willicombe M, Brown EA. Prevalence of frailty and cognitive impairment in older transplant candidates - a preview to the Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study. BMC Nephrol 2022; 23:283. [PMID: 35963988 PMCID: PMC9375902 DOI: 10.1186/s12882-022-02900-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. METHODS The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post-transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable were also eligible for enrolment into the qualitative sub-study. RESULTS Two hundred eight participants have been recruited (age 60-78). Baseline Montreal Cognitive Assessments were available for 173 participants, with 63 (36.4%) participants identified as having scores below normal (score < 26). Edmonton Frail Scale assessments were available for 184 participants, with 29 participants (15.8%) identified as frail (score ≥ 8), and a further 37 participants (20.1%) identified as being vulnerable (score 6-7). CONCLUSION In the KTOP study cohort we have identified a prevalence of 36.4% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 15.8% at recruitment. A further 20.1% were vulnerable. As formal testing for cognition and frailty is not routinely incorporated into the work up of older people across many units, the presence and significance of these conditions is likely not known. Ultimately the KTOP study will report on how these parameters evolve over time and following a transplant, and describe their impact on quality of life and clinical outcomes.
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Affiliation(s)
- Amarpreet K. Thind
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Annabel Rule
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK ,grid.439764.b0000 0004 0449 9187Central London Community Healthcare NHS Trust, Ground Floor, 15 Marylebone Road, London, NW1 5JD UK
| | - Dawn Goodall
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Shuli Levy
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Sarah Brice
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Frank J. M. F. Dor
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK ,grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - Nicola Evans
- grid.420545.20000 0004 0489 3985Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
| | - David Ospalla
- grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Nicola Thomas
- grid.4756.00000 0001 2112 2291Institute of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - David Wellsted
- grid.5846.f0000 0001 2161 9644The Centre for Health Services and Clinical Research, The University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB UK
| | - Lina Johansson
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Michelle Willicombe
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Edwina A. Brown
- grid.7445.20000 0001 2113 8111Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK ,grid.413629.b0000 0001 0705 4923Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
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Brotherton A, Evison F, Gallier S, Sharif A. Pre-operative Waterlow score and outcomes after kidney transplantation. BMC Nephrol 2022; 23:273. [PMID: 35927670 PMCID: PMC9351155 DOI: 10.1186/s12882-022-02902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Waterlow scoring was introduced in the 1980s as a nursing tool to risk stratify for development of decubitus ulcers (pressure sores) and is commonly used in UK hospitals. Recent interest has focussed on its value as a pre-op surrogate marker for adverse surgical outcomes, but utility after kidney transplantation has never been explored. Methods In this single-centre observational study, data was extracted from hospital informatics systems for all kidney allograft recipients transplanted between 1st January 2007 and 30th June 2020. Waterlow scores were categorised as per national standards; 0–9 (low risk), 10–14 (at risk), 15–19 (high risk) and ≥ 20 (very high risk). Multiple imputation was used to replace missing data with substituted values. Primary outcomes of interest were post-operative length of stay, emergency re-admission within 90-days and mortality analysed by linear, logistic or Cox regression models respectively. Results Data was available for 2,041 kidney transplant patients, with baseline demographics significantly different across Waterlow categories. As a continuous variable, the median Waterlow score across the study cohort was 10 (interquartile range 8–13). As a categorical variable, Waterlow scores pre-operatively were classified as low risk (n = 557), at risk (n = 543), high risk (n = 120), very high risk (n = 27) and a large proportion of missing data (n = 794). Median length of stay in days varied significantly with pre-op Waterlow category scores, progressively getting longer with increasing severity of Waterlow category. However, no difference was observed in risk for emergency readmission within 90-days of surgery with severity of Waterlow category. Patients with ‘very high risk’ Waterlow scores had increased risk for mortality at 41.9% versus high risk (23.7%), at risk (17.4%) and low risk (13.4%). In adjusted analyses, ‘very high risk’ Waterlow group (as a categorical variable) or Waterlow score (as a continuous variable) had an independent association with increase length of stay after transplant surgery only. No association was observed between any Waterlow risk group/score with emergency 90-day readmission rates or post-transplant mortality after adjustment. Conclusions Pre-operative Waterlow scoring is a poor surrogate marker to identify kidney transplant patients at risk of emergency readmission or death and should not be utilised outside its intended use. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02902-8.
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Affiliation(s)
- Anna Brotherton
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2WB, UK
| | - Felicity Evison
- Research Informatics, Research Development and Innovation, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Research Informatics, Research Development and Innovation, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK.,PIONEER - HDR-UK Health Data Hub in Acute Care, University of Birmingham, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2WB, UK. .,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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28
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Girerd S, Duarte K, Couchoud C, Laurain E, Courivaud C, Bauwens M, Kessler M, Frimat L, Girerd N. Association between kidney retransplantation and survival according to age in the French national cohort of dialysis patients. Am J Transplant 2022; 22:2028-2040. [PMID: 35510748 PMCID: PMC9542860 DOI: 10.1111/ajt.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 01/25/2023]
Abstract
The mean age of patients returning to dialysis after a first kidney transplantation (KT) has increased in the past decades. We aimed to assess the association between second KT (2KT) and survival according to age at the time of return to dialysis. Data of 5334 patients registered in the French Renal Epidemiology and Information Network (REIN) (mean age 56.6 ± 13.6 years) who returned to dialysis after a first KT were collected. The association of 2KT with death was assessed using a propensity score-based analysis taking into account baseline and follow-up variables. In relisted patients (3272 patients, 61.3%), retransplantation was associated with better overall survival in comparison with patients who remained in dialysis (adjusted HR 0.75 [0.63-0.89], p = .0009). The survival advantage conferred by retransplantation gradually declined with increasing age (adjusted HR 0.41 [0.24-0.70] in patients <50, HR 0.94 (0.69-1.27) in patients aged 70 or older, p for interaction 0.034 for age considered as a continuous variable). 2KT is associated with better survival as opposed to remaining on dialysis after a first kidney graft failure. Nevertheless, this survival benefit is age dependent and diminishes with increasing age. The risk/benefit ratio should be comprehensively assessed in the oldest patients when relisting is considered.
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Affiliation(s)
- Sophie Girerd
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance,Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Kevin Duarte
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance
| | | | - Emmanuelle Laurain
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Cécile Courivaud
- Department of Nephrology, Dialysis, and Renal TransplantationUniversity Hospital of BesançonBesançonFrance
| | - Marc Bauwens
- Department of Nephrology, Dialysis, and Renal TransplantationUniversity Hospital of PoitiersPoitiersFrance
| | - Michèle Kessler
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Luc Frimat
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Nicolas Girerd
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance
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Pérez-Sáez MJ, Arias-Cabrales CE, Redondo-Pachón D, Burballa C, Buxeda A, Bach A, Faura A, Junyent E, Marco E, Rodríguez-Mañas L, Crespo M, Pascual J, Pérez-Sáez MJ, Arias-Cabrales CE, Redondo D, Barbosa F, Cao H, Collado S, Buxeda A, Burballa C, Crespo M, Pascual J, Faura A, Vera M, Bach A, Pedreira G, Junyent E, Folgueiras M, Castillo Y, Martínez A, Fernández M, Barbero E, Causadías R, Calvo A, Carazo J, Frances A, Cecchini L, Marco E, de Valderrama DM, Morgado A, Muñoz E, Nogués X, Rodríguez-Mañas L, Vázquez O, Muns MD, Gárriz M, Gómez MP, Hurtado S, López M, Ribera L, Guino M, Roca R, Calls J, Rovira A, Mora J, Ibrik O, Liria F, López T, Almirall J, Moya C, Moreno F, de Arellano MR, Rubio S, Cidraque I, Pájaro C, Garra N, Galcerán J, Fenollar M, Outón S, Dapena F, Jara J, García R, Manresa M. Increased mortality after kidney transplantation in mildly frail recipients. Clin Kidney J 2022; 15:2089-2096. [PMID: 36325004 PMCID: PMC9613422 DOI: 10.1093/ckj/sfac159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Physical Frailty Phenotype (PFP) is the most used frailty instrument among kidney transplant recipients, classifying patients as pre-frail if they have 1–2 criteria and as frail if they have ≥3. However, different definitions of robustness have been used among renal patients, including only those who have 0 criteria, or those with 0–1 criteria. Our aim was to determine the impact of one PFP criterion on transplant outcomes. Methods We undertook a retrospective study of 296 kidney transplant recipients who had been evaluated for frailty by PFP at the time of evaluating for transplantation. Results Only 30.4% of patients had 0 criteria, and an additional 42.9% showed one PFP criterion. As PFP score increased, a higher percentage of women and cerebrovascular disease were found. Recipients with 0–1 criteria had lower 1-year mortality after transplant than those with ≥2 (1.8% vs 10.1%), but this difference was already present when we only considered those who scored 0 (mortality 1.1%) and 1 (mortality 2.4%) separately. The multivariable analysis confirmed that one PFP criterion was associated to a higher risk of patient death after kidney transplantation [hazard ratio 3.52 (95% confidence interval 1.03–15.9)]. Conclusions Listed kidney transplant candidates frequently show only one PFP frailty criterion. This has an independent impact on patient survival after transplantation.
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Affiliation(s)
| | | | | | - Carla Burballa
- Nephrology Department , Hospital del Mar, Barcelona , Spain
| | - Anna Buxeda
- Nephrology Department , Hospital del Mar, Barcelona , Spain
| | - Anna Bach
- Nephrology Department , Hospital del Mar, Barcelona , Spain
| | - Anna Faura
- Nephrology Department , Hospital del Mar, Barcelona , Spain
| | | | - Ester Marco
- Physical Medicine & Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Research Institute. Universitat Autònoma de Barcelona , Barcelona , Spain
| | | | - Marta Crespo
- Nephrology Department , Hospital del Mar, Barcelona , Spain
| | - Julio Pascual
- Nephrology Department , Hospital del Mar, Barcelona , Spain
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30
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Pérez-Sáez MJ, Redondo-Pachón D, Arias-Cabrales CE, Faura A, Bach A, Buxeda A, Burballa C, Junyent E, Crespo M, Marco E, Rodríguez-Mañas L, Pascual J. Outcomes of Frail Patients While Waiting for Kidney Transplantation: Differences between Physical Frailty Phenotype and FRAIL Scale. J Clin Med 2022; 11:jcm11030672. [PMID: 35160125 PMCID: PMC8836649 DOI: 10.3390/jcm11030672] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Frailty is associated with poorer outcomes among patients waiting for kidney transplantation (KT). Several different tools to measure frailty have been used; however, their predictive value is unknown. This is a prospective longitudinal study of 449 KT candidates evaluated for frailty by the Physical Frailty Phenotype (PFP) and the FRAIL scale. During the study period, 296 patients received a KT, while 153 remained listed. Patients who did not get receive a transplant were more frequently frail according to PFP (16.3 vs. 7.4%, p = 0.013). Robust patients had fewer hospital admissions during the 1st year after listing (20.8% if PFP = 0 vs. 43.4% if ≥1, and 27.1% if FRAIL = 0 vs. 48.9% if ≥1) and fewer cardiovascular events (than FRAIL ≥ 1) or major infectious events (than PFP ≥ 1). According to PFP, scoring 1 point had an impact on patient survival and chance of transplantation in the univariate analysis. The multivariable analysis corroborated the result, as candidates with PFP ≥ 3 had less likelihood of transplantation (HR 0.45 [0.26–0.77]). The FRAIL scale did not associate with any of these outcomes. In KT candidates, pre-frailty and frailty according to both the PFP and the FRAIL scale were associated with poorer results while listed. The PFP detected that frail patients were less likely to receive a KT, while the FRAIL scale did not.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
- Correspondence:
| | - Dolores Redondo-Pachón
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Carlos E. Arias-Cabrales
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Anna Faura
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Anna Bach
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Anna Buxeda
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Carla Burballa
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Ernestina Junyent
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
| | - Ester Marco
- Physical Medicine & Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de L’ESPERANÇA), 08003 Barcelona, Spain;
- Rehabilitation Research Group, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.R.-P.); (C.E.A.-C.); (A.F.); (A.B.); (A.B.); (C.B.); (E.J.); (M.C.); (J.P.)
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31
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Chen X, Liu Y, Thompson V, Chu NM, King EA, Walston JD, Kobashigawa JA, Dadhania DM, Segev DL, McAdams-DeMarco MA. Transplant centers that assess frailty as part of clinical practice have better outcomes. BMC Geriatr 2022; 22:82. [PMID: 35086480 PMCID: PMC8793239 DOI: 10.1186/s12877-022-02777-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/17/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Frailty predicts adverse post-kidney transplant (KT) outcomes, yet the impact of frailty assessment on center-level outcomes remains unclear. We sought to test whether transplant centers assessing frailty as part of clinical practice have better pre- and post-KT outcomes in all adult patients (≥18 years) and older patients (≥65 years). METHODS In a survey of US transplant centers (11/2017-4/2018), 132 (response rate = 65.3%) centers reported their frailty assessment practices (frequency and specific tool) at KT evaluation and admission. Assessment frequency was categorized as never, sometime, and always; type of assessment tool was categorized as none, validated (for post-KT risk prediction), and any other tool. Center characteristics and clinical outcomes for adult patients during 2017-2019 were gleaned from the transplant national registry (Scientific Registry of Transplant Recipients). Poisson regression was used to estimate incidence rate ratios (IRRs) of waitlist outcomes (waitlist mortality, transplantation) in candidates and IRRs of post-KT outcomes (all-cause mortality, death-censored graft loss) in recipients by frailty assessment frequency. We also estimated IRRs of waitlist outcomes by type of assessment tool at evaluation. All models were adjusted for case mix and center characteristics. RESULTS Assessing frailty at evaluation was associated with lower waitlist mortality rate (always IRR = 0.91,95%CI:0.84-0.99; sometimes = 0.89,95%CI:0.83-0.96) and KT rate (always = 0.94,95%CI:0.91-0.97; sometimes = 0.88,95%CI:0.85-0.90); the associations with waitlist mortality rate (always = 0.86,95%CI:0.74-0.99; sometimes = 0.83,95%CI:0.73-0.94) and KT rate (always = 0.82,95%CI:0.77-0.88; sometimes = 0.92,95%CI:0.87-0.98) were stronger in older patients. Furthermore, using validated (IRR = 0.90,95%CI:0.88-0.92) or any other tool (IRR = 0.90,95%CI:0.87-0.93) at evaluation was associated lower KT rate, while only using a validated tool was associated with lower waitlist mortality rate (IRR = 0.89,95%CI:0.83-0.96), especially in older patients (IRR = 0.82,95%CI:0.72-0.93). At admission for KT, always assessing frailty was associated with a lower graft loss rate (IRR = 0.71,95%CI:0.54-0.92) but not with mortality (IRR = 0.93,95%CI:0.76-1.13). CONCLUSIONS Assessing frailty at evaluation is associated with lower KT rate, while only using a validated frailty assessment tool is associated with better survival, particularly in older candidates. Centers always assessing frailty at admission are likely to have better graft survival rates. Transplant centers may utilize validated frailty assessment tools to secure KT access for appropriate candidates and to better allocate health care resources for patients identified as frail, particularly for older patients.
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Affiliation(s)
- Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA
| | - Yi Liu
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA
| | - Valerie Thompson
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A King
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA
| | - Jeremy D Walston
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jon A Kobashigawa
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Darshana M Dadhania
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E Monument Street, Baltimore, MD, 21205, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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32
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Babakry S, Rijkse E, Roodnat JI, Bijdevaate DC, IJzermans JNM, Minnee RC. Risk of post-transplant cardiovascular events in kidney transplant recipients with preexisting aortoiliac stenosis. Clin Transplant 2021; 36:e14515. [PMID: 34674329 PMCID: PMC9285727 DOI: 10.1111/ctr.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Prediction of the risk of cardiovascular events (CVE's) is important to optimize outcomes after kidney transplantation. Aortoiliac stenosis is frequently observed during pre‐transplant screening. We hypothesized that these patients are at higher risk of post‐transplant CVE's due to the joint underlying atherosclerotic disease. Therefore, we aimed to assess whether aortoiliac stenosis was associated with post‐transplant CVE's. This retrospective, single‐center cohort study included adult kidney transplant recipients, transplanted between 2000 and 2016, with contrast‐enhanced imaging available. Aortoiliac stenosis was classified according to the Trans‐Atlantic Inter‐Society Consensus (TASC) II classification and was defined as significant in case of ≥50% lumen narrowing. The primary outcome was CVE‐free survival. Eighty‐nine of 367 patients had significant aortoiliac stenosis and were found to have worse CVE‐free survival (median CVE‐free survival: stenosis 4.5 years (95% confidence interval (CI) 2.8–6.2), controls 8.9 years (95% CI 6.8–11.0); log‐rank test P < .001). TASC II C and D lesions were independent risk factors for a post‐transplant CVE with a hazard ratio of 2.15 (95% CI 1.05–4.38) and 6.56 (95% CI 2.74–15.70), respectively. Thus, kidney transplant recipients with TASC II C and D aortoiliac stenosis require extensive cardiovascular risk management pre‐, peri,‐ and post‐transplantation.
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Affiliation(s)
- Shabnam Babakry
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elsaline Rijkse
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Erasmus MC Transplant Institute, Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik C Bijdevaate
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Erasmus MC Transplant Institute, Division HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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