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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 multisystem 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 examine clinical and research applications of frailty in kidney disease populations. Specifically, we clarify the definition of frailty and address 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 the potential applications of frailty measurement in the 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, School of Medicine, Stanford University, Stanford, California
| | - Rasha Raslan
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Mara McAdams-DeMarco
- Department of Surgery, Langone Health and Grossman School of Medicine, New York University, New York, New York; Department of Population Health, Langone Health and Grossman School of Medicine, New York University, New York, New York
| | - Rasheeda K Hall
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina.
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Ruiz-Margáin A, Macías-Rodríguez RU, Flores-García NC, Román Calleja BM, Fierro-Angulo OM, González-Regueiro JA. Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients. Nutr Clin Pract 2024; 39:14-26. [PMID: 38097210 DOI: 10.1002/ncp.11107] [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: 09/01/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital-Nutritional Prioritizing Tool. Subsequently, a thorough nutrition-focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross-sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual-energy x-ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.
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Affiliation(s)
- Astrid Ruiz-Margáin
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo U Macías-Rodríguez
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nayelli C Flores-García
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Berenice M Román Calleja
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar M Fierro-Angulo
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A González-Regueiro
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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DiLeo MJ, Miggins JJ, Brewer ED, Galván NTN, Rana A. A novel risk score for predicting prolonged length of stay following pediatric kidney transplant. Pediatr Nephrol 2023; 38:4187-4196. [PMID: 37434028 DOI: 10.1007/s00467-023-06066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Kidney transplants (KT) are accepted as the kidney replacement therapy of choice for children with kidney failure. The surgery itself may be more difficult especially in small children, and often leads to significant hospital stays. There is little research on predicting prolonged length of stay (LOS) in children. We aim to examine the factors associated with prolonged LOS following pediatric KT to help clinicians make informed decisions, better counsel families, and potentially reduce preventable causes of prolonged stay. METHODS We retrospectively analyzed the United Network for Organ Sharing database for all KT recipients less than 18 years old between January 2014 and July 2022 (n = 3693). Donor and recipient factors were tested in univariate and multivariate logistic analysis using stepwise elimination of non-significant factors to create a final regression model predicting LOS longer than 14 days. Values were assigned to significant factors to create risk scores for each individual patient. RESULTS In the final model, only primary diagnosis of focal segmental glomerulosclerosis, dialysis prior to KT, geographic region, and recipient weight prior to KT were significant predictors of LOS longer than 14 days. The C-statistic of the model is 0.7308. The C-statistic of the risk score is 0.7221. CONCLUSIONS Knowledge of the risk factors affecting prolonged LOS following pediatric KT can help identify patients at risk of increased resource use and potential hospital-acquired complications. Using our index, we identified some of these specific risk factors and created a risk score that can stratify pediatric recipients into low, medium, or high risk groups. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michael J DiLeo
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA.
| | - John J Miggins
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | - Eileen D Brewer
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - N Thao N Galván
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abbas Rana
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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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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Mizerska A, Durlik M, Kędzierska-Kapuza K. Nutritional Risk of Candidates for Simultaneous Pancreatic-Kidney Transplantation-A Narrative Review. Nutrients 2023; 15:4179. [PMID: 37836461 PMCID: PMC10574362 DOI: 10.3390/nu15194179] [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: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Not much is known about the significance of nutritional status and support in transplant surgery, least of all in simultaneous pancreatic and kidney transplantation. Malnutrition in the context of simultaneous pancreatic-kidney transplantation seems to be complex and a still poorly investigated problem. Since SPKTX is highly qualified and also has a small volume procedure, it is difficult to obtain data from large cohorts of patients. The aim of this article is to gather existing evidence and information about the subject, as well as to elicit some questions and goals for the future. METHODS We searched through the Pub-Med database using the keywords "pancreas and kidney transplantation" combined with "nutritional risk", "nutritional status", "malnutrition", "nutritional intervention", and "frailty", finding a total of 4103 matching results. We then narrowed it down to articles written in English with the full text available. We also researched through the references of articles most accurately matching our researched terms. RESULTS There are numerous tools that have been investigated for the screening of malnutrition, such as the NRI index, PNI index, NLR, SGA scale, and NRS-2002 scale, each of which proved to be of some use in predicting patient outcomes in different surgical settings. Since all of them differed in components and assessed parameters and, in the absence of more sensitive or infallible indicators, the most reasonable approach seems to evaluate them jointly. CONCLUSION It is important to underline the necessity of nutritional screening and the subsequent introduction of adequate therapy while awaiting transplantation in an attempt to improve results. Considering the complexity of surgical procedures and the severity of underlying diseases with their intense metabolic components, the patient's nutritional status seems to significantly influence results. Consequently, nutritional risk assessments should be a part of the routine care of patients qualified for transplantation.
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Affiliation(s)
- Agnieszka Mizerska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Karolina Kędzierska-Kapuza
- Department of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Marymoncka St. 99/103, 01-813 Warsaw, Poland
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Fulinara CP, Huynh A, Goldwater D, Abdalla B, Schaenman J. Frailty and Age-Associated Assessments Associated with Chronic Kidney Disease and Transplantation Outcomes. J Transplant 2023; 2023:1510259. [PMID: 37038595 PMCID: PMC10082678 DOI: 10.1155/2023/1510259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
Background. Frailty is often defined as a decrease in physiological reserve and has been shown to be correlated with adverse health outcomes and mortality in the general population. This condition is highly prevalent in the chronic kidney disease (CKD) patient population as well as in kidney transplant (KT) recipients. Other age-associated changes include sarcopenia, nutrition, cognition, and depression. In assessing the contributions of these components to patient outcomes and their prevalence in the CKD and KT patient population, it can be determined how such variables may be associated with frailty and the extent to which they may impact the adverse outcomes an individual may experience. Objectives. We sought to perform a systematic literature review to review published data on frailty and associated age-associated syndromes in CKD and KT patients. Results. Over 80 references pertinent to frailty, sarcopenia, nutrition, cognition, or depression in patients with CKD or KT were identified. Systematic review was performed to evaluate the data supporting the use of the following approaches: Fried Frailty, Short Physical Performance Battery, Frailty Index, Sarcopenia Index, CT scan quantification of muscle mass, health-related quality of life, and assessment tools for nutrition, cognition, and depression. Conclusion. This report represents a comprehensive review of previously published research articles on this topic. The intersectionality between all these components in contributing to the patient’s clinical status suggests a need for a multifaceted approach to developing comprehensive care and treatment for the CKD and KT population to improve outcomes before and after transplantation.
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Affiliation(s)
- Christian P. Fulinara
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Alina Huynh
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Deena Goldwater
- Divisions of Geriatrics and Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Basmah Abdalla
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joanna Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Lee YK, Motwani Y, Brook J, Martin E, Seligman B, Schaenman J. Predictors of COVID-19 outcomes: Interplay of frailty, comorbidity, and age in COVID-19 prognosis. Medicine (Baltimore) 2022; 101:e32343. [PMID: 36595791 PMCID: PMC9794263 DOI: 10.1097/md.0000000000032343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prior research has identified frailty, comorbidity, and age as predictors of outcomes for patients with coronavirus disease 2019 (COVID-19), including mortality. However, it remains unclear how these factors play different roles in COVID-19 prognosis. This study focused on correlations between frailty, comorbidity and age, and their correlations to discharge outcome and length-of-stay in hospitalized patients with COVID-19. Clinical data was collected from 56 patients who were ≥50 years old and admitted from March 2020 to June 2020 primarily for COVID-19. Frailty Risk Score (FRS) and the Charlson Comorbidity Index (CCI) were used for assessment of frailty and comorbidity burden, respectively. Age had significant positive correlation with FRS and CCI (P < .001, P < .001, respectively). There was also significant positive correlation between FRS and CCI (P < .001). For mortality, patients who died during their hospitalization had significantly higher FRS and CCI (P = .01 and P < .001, respectively) but were not significantly older than patients who did not. FRS, CCI, and age were all significantly associated when looking at overall adverse discharge outcome (transfer to other facility or death) (P < .001, P = .005, and P = .009, respectively). However, none of the 3 variables were significantly correlated with length-of-stay. Multivariate analysis showed FRS (P = .007) but not patient age (P = .967) was significantly associated with death. We find that frailty is associated with adverse outcomes from COVID-19 and supplants age in multivariable analysis. Frailty should be part of risk assessment of older adults with COVID-19.
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Affiliation(s)
- Yoon Kyung Lee
- UCLA David Geffen School of Medicine, Los Angeles, CA
- * Correspondence: Yoon Kyung Lee, UCLA David Geffen School of Medicine, Los Angeles, CA 90024 (e-mail: )
| | - Yash Motwani
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Jenny Brook
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Emily Martin
- UCLA Division of Infectious Diseases, Los Angeles, CA
| | - Benjamin Seligman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- West LA VA Geriatric Medicine, Los Angeles, CA
| | - Joanna Schaenman
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA
- UCLA Division of Infectious Diseases, Los Angeles, CA
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Kao J, Reid N, Hubbard RE, Homes R, Hanjani LS, Pearson E, Logan B, King S, Fox S, Gordon EH. Frailty and solid-organ transplant candidates: a scoping review. BMC Geriatr 2022; 22:864. [PMID: 36384461 PMCID: PMC9667636 DOI: 10.1186/s12877-022-03485-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is currently no consensus as to a standardized tool for frailty measurement in any patient population. In the solid-organ transplantation population, routinely identifying and quantifying frailty in potential transplant candidates would support patients and the multidisciplinary team to make well-informed, individualized, management decisions. The aim of this scoping review was to synthesise the literature regarding frailty measurement in solid-organ transplant (SOT) candidates. METHODS A search of four databases (Cochrane, Pubmed, EMBASE and CINAHL) yielded 3124 studies. 101 studies (including heart, kidney, liver, and lung transplant candidate populations) met the inclusion criteria. RESULTS We found that studies used a wide range of frailty tools (N = 22), including four 'established' frailty tools. The most commonly used tools were the Fried Frailty Phenotype and the Liver Frailty Index. Frailty prevalence estimates for this middle-aged, predominantly male, population varied between 2.7% and 100%. In the SOT candidate population, frailty was found to be associated with a range of adverse outcomes, with most evidence for increased mortality (including post-transplant and wait-list mortality), post-operative complications and prolonged hospitalisation. There is currently insufficient data to compare the predictive validity of frailty tools in the SOT population. CONCLUSION Overall, there is great variability in the approach to frailty measurement in this population. Preferably, a validated frailty measurement tool would be incorporated into SOT eligibility assessments internationally with a view to facilitating comparisons between patient sub-groups and national and international transplant services with the ultimate goal of improved patient care.
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Affiliation(s)
- Jonathan Kao
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland, Australia.
- Geriatrics and Rehabilitation Unit, Building 7 Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
| | - Ruth E Hubbard
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
| | - Ryan Homes
- School of Biomedical Science, The University of Queensland, Queensland, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
| | - Ella Pearson
- School of Biomedical Science, The University of Queensland, Queensland, Australia
| | - Benignus Logan
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
| | - Shannon King
- North Metropolitan Health Service, WA Health, Western Australia, Australia
| | - Sarah Fox
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
- The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Emily H Gordon
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Queensland, Australia
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Lee YK, Shukman M, Biniwale R, Ardehali A, Kamath M, Nsair A, Schaenman JM, Goldwater D. Benefits of both physical assessment and electronic health record review to assess frailty prior to heart transplant. Clin Transplant 2022; 36:e14559. [PMID: 34923657 PMCID: PMC9366897 DOI: 10.1111/ctr.14559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown. METHODS This single-center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart-review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep. RESULTS We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P = .043, P < .001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P = .022; P = .002) and not being transplanted (P = .026; P = .008). Higher frailty by SPPB and FFP was also associated with mortality (P = .010; P = .025). CONCLUSION SPPB and chart-review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations.
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Affiliation(s)
- Yoon Kyung Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marina Shukman
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reshma Biniwale
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbas Ardehali
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Megan Kamath
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ali Nsair
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joanna M. Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Deena Goldwater
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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10
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Gee S, Lee Y, Shah A, Izadmehr E, Belperio J, Shino Y, Weigt S, Goldwater D, Schaenman J. Predictive value of chart-based frailty evaluation for lung transplant candidates. Clin Transplant 2021; 36:e14461. [PMID: 34486175 DOI: 10.1111/ctr.14461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Frailty, defined as a state of decreased physiologic reserve, has been correlated with poorer outcomes after hospitalization or surgery. Studies in lung transplant patients have associated frailty with an increased risk of post-transplant mortality; however, a unified approach is lacking. The identification of frail patients can help clinicians pre-emptively target modifiable risk factors and may facilitate risk stratification. The Frailty Risk Score (FRS) is a chart review-based approach based on eight symptoms and four laboratory biomarkers. We applied this method in a retrospective study to investigate its utility in predicting post-transplant lung outcomes. Eighty-four lung transplant recipients were evaluated, including 51 older (≥ 60) and 33 younger (< 60) patients. Median FRS score was 3.9, with 63 categorized as frail (75%) and 21 as non-frail (25%), using a previously published cut-off of ≥3 to define frailty. A high FRS was associated with readmission in the first year after transplantation and with the number of readmissions. There was also an association between FRS score and death (p = .047). FRS may be a viable tool in the assessment of lung transplant candidates. Frail patients may benefit from earlier referral and targeted therapy prior to transplant, as well as close post-transplant follow-up.
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Affiliation(s)
- Serina Gee
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yoon Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Aloukika Shah
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ehsan Izadmehr
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - John Belperio
- UCLA Department of Medicine, Division of Pulmonary Disease, Los Angeles, California, USA
| | - Yusaku Shino
- UCLA Department of Medicine, Division of Pulmonary Disease, Los Angeles, California, USA
| | - Sam Weigt
- UCLA Department of Medicine, Division of Pulmonary Disease, Los Angeles, California, USA
| | - Deena Goldwater
- UCLA Department of Medicine, Division of Geriatrics, Los Angeles, California, USA
| | - Joanna Schaenman
- UCLA Department of Medicine, Division of Infectious Disease, Los Angeles, California, USA
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Quint EE, Zogaj D, Banning LB, Benjamens S, Annema C, Bakker SJ, Nieuwenhuijs-Moeke GJ, Segev DL, McAdams-DeMarco MA, Pol RA. Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis. Transplant Direct 2021; 7:e701. [PMID: 34036171 PMCID: PMC8133203 DOI: 10.1097/txd.0000000000001156] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Frailty is a multidimensional condition and is the result of the body's age-associated decline in physical, cognitive, physiological, and immune reserves. The aim of this systematic review is to assess the quality of evidence of the included studies, determine the prevalence of frailty among kidney transplant candidates, and evaluate the relationship between frailty and associated patient characteristics and outcomes after kidney transplantation. METHODS A systematic search was performed for relevant literature on frailty and kidney transplantation. This was followed by a meta-analysis for patient characteristics and outcomes reported by a minimum of 2 studies including mean age, gender, mean body mass index, type of kidney transplantation, dialysis, previous kidney transplantation, comorbidities, hypertension, race, preemptive kidney transplantation, delayed graft function, and length of stay. RESULTS A total of 18 studies were included in the systematic review and 14 of those studies were suitable for meta-analysis. The overall pooled prevalence of frailty before transplantation was estimated at 17.1% (95% confidence interval [CI], 15.4-18.7). Frailty was significantly associated with higher age (mean difference, 3.6; 95% CI, 1.4-5.9), lower rate of preemptive transplantation (relative risk, 0.60; 95% CI, 0.4-0.9), longer duration of delayed graft function (relative risk, 1.80; 95% CI, 1.1-3.0), and length of stay longer than 2 wk (odds ratio, 1.64; 95% CI, 1.2-2.3). CONCLUSIONS One in 6 kidney transplant recipients is frail before transplantation. The presence of frailty is associated with lower rates of preemptive transplantation, older recipient age, higher rates of delayed graft function, and longer length of stay. Future research is required to explore the association of frailty with other adverse outcomes after kidney transplantation and the effects of intervention programs to improve the different frailty domains.
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Affiliation(s)
- Evelien E. Quint
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Donika Zogaj
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Louise B.D. Banning
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stan Benjamens
- Division of Transplantation Surgery, Department of Surgery, 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
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Robert A. Pol
- Division of Transplantation Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Wang Y, Heemskerk MBA, Michels WM, de Vries APJ, Dekker FW, Meuleman Y. Donor type and 3-month hospital readmission following kidney transplantation: results from the Netherlands organ transplant registry. BMC Nephrol 2021; 22:155. [PMID: 33902492 PMCID: PMC8077946 DOI: 10.1186/s12882-021-02363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hospital readmission after transplantation is common in kidney transplant recipients (KTRs). In this study, we aim to compare the risk of 3-month hospital readmission after kidney transplantation with different donor types in the overall population and in both young (< 65 years) and elderly (≥65 years) KTRs. METHODS We included all first-time adult KTRs from 2016 to 2018 in the Netherlands Organ Transplant Registry. Multivariable logistic regression models were used to estimate the effect while adjusting for baseline confounders. RESULTS Among 1917 KTRs, 615 (32.1%) had at least one hospital readmission. Living donor kidney transplantation (LDKT) recipients had an adjusted OR of 0.76 (95%CI, 0.61 to 0.96; p = 0.02) for hospital readmission compared to deceased donor kidney transplantation (DDKT) recipients. In the young and elderly, the adjusted ORs were 0.69 (95%CI, 0.52 to 0.90, p = 0.01) and 0.93 (95%CI, 0.62 to 1.39, p = 0.73) and did not differ significantly from each other (p-value for interaction = 0.38). In DDKT, the risk of hospital readmission is similar between recipients with donation after cardiac death (DCD) or brain death (DBD) and the risk was similar between the young and elderly. CONCLUSION A lower risk of post-transplant 3-month hospital readmission was found in recipients after LDKT compared to DDKT, and this benefit of LDKT might be less dominant in elderly patients. In DDKT, having either DCD or DBD donors is not associated with post-transplant 3-month hospital readmission, regardless of age. Tailored patient management is needed for recipients with DDKT and elderly KTRs.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | | | - Wieneke M Michels
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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13
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Gao K, Li BL, Yang L, Zhou D, Ding KX, Yan J, Gao YJ, Huang XR, Zheng XP. Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults. Sci Rep 2021; 11:7776. [PMID: 33833338 PMCID: PMC8032763 DOI: 10.1038/s41598-021-87444-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/09/2022] Open
Abstract
This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.
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Affiliation(s)
- Ke Gao
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Bo-Lin Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Lei Yang
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Dan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kang-Xi Ding
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ju Yan
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, Xinjiang, China
| | - Ya-Jie Gao
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiao-Rui Huang
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiao-Pu Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China. .,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China.
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14
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Salas MAP, Rodriguez-Abreu RD, Amaechi P, Rao V, Soliman K, Taber D. Clinical Outcomes of Older Kidney Transplant Recipients. Am J Med Sci 2021; 362:130-134. [PMID: 33640364 DOI: 10.1016/j.amjms.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Older kidney transplant recipients (OKTR) are vulnerable to infections and AKI, often prompting hospitalization. This study elucidates etiology of hospitalizations, AKI, and outcomes in OKTR. METHODS Retrospective study of 500 patients age ≥ 60, who underwent kidney transplantation from 2005-2015. Demographic, transplant, and outcomes data were collected. RESULTS OKTR had mean age 66 years; 59% males and 50% African Americans. 62% had at least one hospitalization post-transplant. Predictors of hospitalization were DGF, DM, panel reactive antibodies (PRA), dialysis duration. Hospitalization was mostly due to infection and surgical complications. Average length of stay was 6.4 days. OKTR with at least one hospitalization had 84% higher risk for graft loss (p=0.001). 56% of older kidney transplant recipients had at least one AKI episode post-transplant. Predictors of AKI included DGF, older, African American donor, and tacrolimus variability. The most common etiologies for AKI were infection, dehydration, and GI complications. OKTR with at least one AKI episode had 2.6-fold higher risk for graft loss (p<0.001). CONCLUSIONS Post-transplant hospitalization and AKI in OKTR significantly impact graft survival. Addressing comorbidities and risks in the pre-transplant and outpatient setting may help alleviate burden of hospitalization and risk of AKI in OKTR and improve graft outcomes.
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Affiliation(s)
- Maria Aurora Posadas Salas
- Division of Nephrology and Hypertension, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | | | - Prince Amaechi
- Spartanburg Nephrology Associates, Spartanburg, SC, United States
| | - Vinaya Rao
- Division of Nephrology and Hypertension, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Karim Soliman
- Division of Nephrology and Hypertension, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - David Taber
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
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15
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Frailty in Lung Transplantation - Candidate Assessment and Optimization. Transplantation 2021; 105:2201-2212. [PMID: 33982913 DOI: 10.1097/tp.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concept of frailty has gained considerable interest in clinical solid organ transplantation over the past decade. Frailty as a phenotypic construct to describe a patient's risk from biologic stresses, has an impact on posttransplant survival. There is keen interest in characterizing frailty in lung transplantation, both to determine which patients are suitable candidates for listing and also to prepare for their care in the aftermath of lung transplantation. Here we review the current status of research on frailty in lung transplant candidates and recipients. This review will highlight areas of uncertainty for frailty in clinical lung transplantation which are likely to impact the state-of-the-art in the field for the next decade.
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16
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Deliège PG, Braconnier A, Chaix F, Renard Y, Petrache A, Guyot-Colosio C, Kazes I, Mokri L, Barbe C, Rieu P. Skeletal Muscle Index as a Prognostic Marker for Kidney Transplantation in Older Patients. J Ren Nutr 2020; 31:286-295. [PMID: 33139208 DOI: 10.1053/j.jrn.2020.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/05/2020] [Accepted: 08/30/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Low skeletal muscle mass has emerged as a risk factor for mortality after liver transplantation. We evaluated the prognostic value of muscle mass on length of hospitalization and adverse outcomes after kidney transplantation in aging end-stage renal disease patients. METHODS One hundred twenty-two patients aged 60 years or older at the time of transplantation were retrospectively analyzed. Skeletal muscle index (SMI), evaluated by computed tomography scan, was calculated from total muscle surface area at L3 vertebral level divided by body height squared. Outcomes were compared according to SMI (namely, length of hospitalization, wound complications, combined endpoint comprising all-cause mortality, and graft failure within 1 year). RESULTS In male patients, by multivariate analysis, a low SMI (<42 cm2/m2) was associated with longer immediate post-transplantation hospitalization (β = 17.03 ± 4.3; P = .0002), longer total hospitalization during the first year (β = 34.3 ± 10.7; P = .002), higher rate of wound complications (odds ratio = 12.1 [1.9-77.0]; P = .008), and higher rate of the combined endpoint of graft loss or death (odds ratio = 3.4 [3.0-399.5]; P = .004). In female patients, low SMI was not associated with length of hospitalization or adverse outcomes after transplantation. CONCLUSION SMI is an independent marker of morbidity and mortality after kidney transplantation in older men and could help thereby nephrologists better select aging candidates for kidney transplantation with a view to improving post-transplant outcomes.
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Affiliation(s)
| | | | - Floriane Chaix
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Yohann Renard
- Department of General and Digestive Surgey, University Hospital of Reims, Reims, France
| | - Andreaa Petrache
- Department of Nephrology, University Hospital of Reims, Reims, France
| | | | - Isabelle Kazes
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Laetitia Mokri
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Coralie Barbe
- Department of Biostatistics, University Hospital of Reims, Reims, France
| | - Philippe Rieu
- Department of Nephrology, University Hospital of Reims, Reims, France; Laboratory of Nephrology, UMR CNRS URCA, 7369 (Matrice Extracellulaire et Dynamique Cellulaire, MEDyC), Reims, France
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17
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Thompson C, Taleban S. Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s11938-020-00310-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Wu HH, Woywodt A, Nixon AC. Frailty and the Potential Kidney Transplant Recipient: Time for a More Holistic Assessment? KIDNEY360 2020; 1:685-690. [PMID: 35372945 PMCID: PMC8815542 DOI: 10.34067/kid.0001822020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/22/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew C. Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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