Depressive symptoms, frailty, and adverse outcomes among kidney transplant recipients

Abstract

Depressive symptoms and frailty are each independently associated with morbidity and mortality in kidney transplant (KT) recipients. We hypothesized that having both depressive symptoms and frailty would be synergistic and worse than the independent effect of each. In a multicenter cohort study of 773 KT recipients, we measured the Fried frailty phenotype and the modified 18-question Center for Epidemiologic Studies-Depression Scale (CES-D). Using adjusted Poisson regression and survival analysis, we tested whether depressive symptoms (CES-D score > 14) and frailty were associated with KT length of stay (LOS), death-censored graft failure (DCGF), and mortality. At KT admission, 10.0% of patients exhibited depressive symptoms, 16.3% were frail, and 3.6% had both. Recipients with depressive symptoms were more likely to be frail (aOR = 3.97, 95% CI: 2.28-6.91, P < 0.001). Recipients with both depressive symptoms and frailty had a 1.88 times (95% CI: 1.70-2.08, P < 0.001) longer LOS, 6.20-fold (95% CI:1.67-22.95, P < 0.01) increased risk of DCGF, and 2.62-fold (95% CI:1.03-6.70, P = 0.04) increased risk of mortality, compared to those who were nonfrail and without depressive symptoms. There was only evidence of synergistic effect of frailty and depressive symptoms on length of stay (P for interaction< 0.001). Interventions aimed at reducing pre-KT depressive symptoms and frailty should be explored for their impact on post-KT outcomes.

Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients

“…The effect of frailty on length of stay is especially pronounced in patients with depressive symptoms (1.9 fold increase in risk). 23 Pre-transplant hospitalization, a surrogate measure of frailty, is also associated with increase post-transplant hospitalization (0 hospital days: 73%; 1–7 days: 70%; 8–14 days: 75%; ≥15 days: 80% hospitalization by 12 months of transplant) 24 .…”

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

“…Among kidney transplantation (KT) candidates, frailty is associated with decreased access to KT [19], waitlist mortality [19-21], cognitive impairment [22], and poor health-related quality of life [23]. KT recipients who are frail at the time of admission for transplantation are more likely to experience depressive symptoms [24], poor health-related quality of life [25], longer length of stay [26], delirium [27], delayed graft function [28], reduction in mycophenolate mofetil immunosuppression dose [29], early hospital readmission [30], and mortality [31, 32]. Importantly, the association between frailty and these adverse outcomes does not differ by whether the patients were older or younger, suggesting that frailty is equally as predictive for older and younger patients.…”

Frailty is associated with dialysis duration before transplantation in kidney transplant recipients: A Japanese single‐center cross‐sectional study

“…Potential causes of frailty in chronic kidney disease patients have been reported to be age, sex, BMI, education, comorbidities, serum creatinine levels, serum testosterone levels, serum albumin levels, depression and disability. [14][15][16][17]22,23 A priori, we selected seven covariates, including age, sex, BMI, time after transplant, dialysis duration before transplant, eGFR and serum albumin levels, to avoid overfitting. Multivariable analysis showed that dialysis duration was positively correlated with frailty.…”

“…It has been reported that kidney transplant recipients with depressive symptoms were more likely to have frailty, and kidney transplant recipients who had both frailty and depression were associated with increased adverse outcomes. 23 Furthermore, the KCL is beneficial, because it is an easy-to-answer self-reported questionnaire, and it might be an appropriate assessment for frailty in kidney transplant recipients at outpatient departments.…”

“…The KCL consists of 25 items that are self-reported "yes/no" questions and are divided into seven domains: (i) instrumental activities of daily living (questions 1-5); (ii) physical function (questions 6-10); (iii) nutrition (questions 11-12); (iv) eating (questions 13-15); (v) socialization (questions [16][17]; (vi) memory (questions [18][19][20]; and (vii) depression (questions [21][22][23][24][25]. Difficulty with any question is counted as a point on the KCL, with a higher score in each domain of the KCL indicating a higher risk for requiring support or care in that domain.…”