Changes in Frailty After Kidney Transplantation

McAdams‐DeMarco, Mara; Isaacs, K.; Darko, Louisa; Salter, Megan L.; Gupta, Natasha; King, Elizabeth A.; Walston, Jeremy D.; Segev, Dorry L.

doi:10.1111/jgs.13657

Cited by 147 publications

(151 citation statements)

References 25 publications

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“…Among recipients of a kidney transplant who met CHS criteria for frailty, nearly three-quarters were non- or intermediately frail three months post-procedure. (143) …”

Section: Discussionmentioning

confidence: 99%

“…(164) While it has been suggested that “frailty” is a euphemism for patients who are terminally ill, (165) frailty may not progress in the short term and, in select cases, may be reversible. (43,143) The possibility of modifiable contributors should always be considered. Accurate information on the relative benefits and risks (including burden) of available therapies is needed for informed decision-making.…”

Section: Discussionmentioning

confidence: 99%

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A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

et al. 2017

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There is general agreement that frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency, but unresolved issues persist about its detection, underlying pathophysiology, and relationship with aging, disability, and multimorbidity. A particularly challenging area is the relationship between frailty and hospitalization. Based on the deliberations of a 2014 Canadian expert consultation meeting and a scoping review of the relevant literature between 2005 and 2015, this discussion paper presents a review of the current state of knowledge on frailty in the acute care setting, including its prevalence and ability to both predict the occurrence and outcomes of hospitalization. The examination of the available evidence highlighted a number of specific clinical and research topics requiring additional study. We conclude with a series of consensus recommendations regarding future research priorities in this important area.

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“…Among recipients of a kidney transplant who met CHS criteria for frailty, nearly three-quarters were non- or intermediately frail three months post-procedure. (143) …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

et al. 2017

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“…Fragility represents a measure of the physiological reserve that is related as a risk factor for adverse effects of renal transplantation, such as delayed graft function, early hospital readmission and mortality. The decline in physiological reserve promotes an increased vulnerability to stressors resulting from a deregulation of multiple physiological systems, and this may directly affect the functionality of these individuals 12,13,14,15 .…”

Section: Introductionmentioning

confidence: 99%

Functional independence and mobility in kidney transplanted patients: cross-sectional study

Maia

Rocha

Bezerra

et al. 2017

Motriz: rev. educ. fis.

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-Aim -To assess functional independence, balance and mobility of kidney transplant recipients, to verify transplant time, donor type, regular exercise practice, musculoskeletal complaints, as well as association among these variables. Methods: Observational study with 86 kidney transplant individuals, subjected to evaluation of the Functional Independence Measure (FIM) and Timed Up and Go test (TUG). Results: The mean age of the study population was 43.98 years old, 50% of these individuals were between 5-10 years of transplantation and 50% between 10-15 years. Changes in mobility and balance (TUG) were found in 9.3% of transplant patients, while 2.3% had deficits in functional independence (FIM). The association between TUG and the FIM (χ2= 19.964, p< 0.001) was found in 25% of the 9.3% of individuals who showed changes in TUG. It was found that only 20.9% of kidney transplant between 5-10 years and 14.0% between 11 and 15 years performed regular physical exercises (χ2= 0.727, p= 0.394) and 67.4% presented prevalent complaints on lower limbs musculoskeletal. Conclusion: Although the level of dependence and impairments in mobility and balance found in renal transplants are low, deficits in mobility and balance may lead to changes in the ability to perform their functional activities independently.

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“…Frailty is a useful marker of health status and can be used to monitor response to interventions; an example of this can be seen in the study by McAdams de Marco and colleagues who explored how frailty status changed before and after kidney transplantation (34).…”

Section: Discussionmentioning

confidence: 99%

“…23,25,26,29- 33 Frailty also predicted an increased risk of falls in patients with CKD. 34,42 In the kidney transplant recipient, frailty was associated with an increased risk of early hospital readmission and delayed graft function. 35,36 Patients who were frail prior to transplantation were also more likely to have improvement in frailty after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Frailty in chronic kidney disease

Chowdhury¹

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Frailty is regarded as the most problematic consequence of aging. Whilst there is no precise definition for frailty, most clinicians agree that patients who are frail are vulnerable to poor health.Frailty can be conceptualised as a syndrome with a set of symptoms and signs that are measured to give a categorical classification of frailty as described by Fried and colleagues. Alternatively, frailty can be considered as a state, where deficits in health across multiple organ systems accumulate over time. These deficits are summated to give a continuous measure of frailty called the frailty index (FI).Patients with chronic kidney disease (CKD) are at risk of frailty. CKD has effects in multiple systems and it leads to accelerated manifestation of frailty, especially in those who are on dialysis.The Fried approach to frailty assessment has been applied in numerous settings of patients with CKD. However, there are limitations of the Fried approach especially when the prevalence of frailty is high, and a more precise measure is needed of the severity of frailty in an individual.The thesis begins with a systematic review of frailty in patients with CKD. It focuses on how frailty is assessed, including the Fried approach and other assessment methods; differences in frailty between dialysis and pre-dialysis patients; and how frailty changes across the spectrum of severity in kidney function. The systematic review yielded 37 articles encompassing 53,000 patients with CKD. The most common method of frailty assessment was the Fried approach (n=27 articles, 73%).The prevalence of frailty ranged between 7% in a population of pre-dialysis patients with CKD to 73% in patients on dialysis. There was considerable heterogeneity in how the studies defined the Fried phenotype and this impacted on the reported prevalence of frailty. Regardless of the method of assessment, frailty was associated with an increased risk of mortality and hospitalization.The systematic review highlighted gaps in the current evidence, especially in better delineating risk amongst patients on dialysis where the prevalence of frailty may be high. This leads to the next chapter of the thesis, a prospective study of the Frailty Index in CKD (FI-CKD). The aim of the study was to investigate the frailty index (FI) in outpatients with pre-dialysis and dialysis dependent CKD. Associations between FI and kidney function were explored as well as the relationship between FI and change in kidney function, mortality and hospitalization after twelve months of follow up. Amongst 314 patients, the mean FI was 0.29 (SD 0.13) corresponding to a clinical description of mild to moderate frailty. FI was associated with an increased risk of mortality (OR:1.8; 95% CI 1.77 -2.44) and hospitalization (OR 1.3 95% CI 1.06-1.5). Patients with a higher CKD stage were significantly more likely to have a higher FI. However, there was no significant 2 differences in the average FI between dialysis and pre-dialysis patients, perhaps due to the limited number of patients on dialysi...

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Changes in Frailty After Kidney Transplantation

Cited by 147 publications

References 25 publications

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

Functional independence and mobility in kidney transplanted patients: cross-sectional study

Frailty in chronic kidney disease

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