Frailty in Dialysis-Dependent Patients With End-Stage Renal Disease

Kutner, Nancy G.; Zhang, Rebecca

doi:10.1001/2013.jamainternmed.750

Cited by 9 publications

(5 citation statements)

References 2 publications

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“…For example, our study may not be generalizable to KT recipients who received less than one year of maintenance dialysis prior to KT. However, most KT recipients receive some dialysis before transplant, and for many, long waiting times necessitate prolonged dialysis exposure, which is strongly associated with worsening health status [ 27 , 65 ]. Our study sample was also diverse and nationally representative, as Fresenius Medical Care provided dialysis services to one third of all dialysis patients in the US during the study period [ 16 , 38 ], such that 40 of the 50 US states were represented in the cohort.…”

Section: Discussionmentioning

confidence: 99%

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation

Harhay¹,

Hill²,

Wang³

et al. 2016

PLoS ONE

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BackgroundEarly rehospitalization (<30 days) after discharge from kidney transplantation (KT) is associated with poor outcomes. We explored summary metrics of pre-transplant health status that may improve the identification of KT recipients at risk for early rehospitalization and mortality after transplant.Materials and MethodsWe performed a retrospective cohort study of 8,870 adult (≥ 18 years) patients on hemodialysis who received KT between 2000 and 2010 at United States transplant centers. We linked Medicare data to United Network for Organ Sharing data and data from a national dialysis provider to examine pre-KT (1) Elixhauser Comorbidity Index, (2) physical function (PF) measured by the Short Form 36 Health Survey, and (3) the number of hospitalizations during the 12 months before KT as potential predictors of early rehospitalization after KT. We also explored whether these metrics are confounders of the known association between early rehospitalization and post-transplant mortality.ResultsThe median age was 52 years (interquartile range [IQR] 41, 60) and 63% were male. 29% were rehospitalized in <30 days, and 20% died during a median follow-up time of five years (IQR 3.6–6.5). In a multivariable logistic model, kidney recipients with more pre-KT Elixhauser comorbidities (adjusted odds ratio [aOR] 1.09 per comorbidity, 95% Confidence Interval [CI] 1.07–1.11), the poorest pre-KT PF (aOR 1.24, 95% CI 1.08–1.43), or >1 pre-KT hospitalizations (aOR 1.32, 95% CI 1.17–1.49) were more likely to be rehospitalized. All three health status metrics and early rehospitalization were independently associated with post-KT mortality in a multivariable Cox model (adjusted hazard ratio for rehospitalization: 1.41, 95% CI 1.28–1.56)ConclusionsPre-transplant metrics of health status, measured by dialysis providers or administrative data, are independently associated with early rehospitalization and mortality risk after KT. Transplant providers may consider utilizing metrics of pre-KT global health status as early signals of vulnerability when transitioning care after KT.

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Section: Discussionmentioning

confidence: 99%

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation

Harhay¹,

Hill²,

Wang³

et al. 2016

PLoS ONE

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“…However, the modified Fried criteria do not include psychosocial or cognitive deficits that may adversely impact health status as much as physical decline [8]. Furthermore, some criteria, particularly patient-reported poor physical function, may represent signs and symptoms of CKD itself [10] and, noting the reported prevalence of frailty at 73% at dialysis initiation [7], the dichotomous classification (frail/non-frail) may have limited utility for clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and construct validity of a Frailty index for patients with chronic kidney disease

et al. 2015

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“…Numerous factors may be maintaining the wide gap in pretransplant dialysis durations between DDKT recipients with and without preemptive listing under the new KAS. For example, individuals who begin maintenance dialysis before being wait‐listed may encounter numerous additional health burdens that delay transplant referral and prolong waiting time, including increased risks of functional dependence, vascular disease, and hospitalizations . Delayed transplant referral after dialysis onset may also be a reflect variation in dialysis center transplant referral practices, a factor that is coming under increasing scrutiny as a potential quality‐of‐care indicator …”

Section: Resultsmentioning

confidence: 99%

Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait‐listing status

Harhay

Ranganna

et al. 2018

Clinical Transplantation

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Frailty in Dialysis-Dependent Patients With End-Stage Renal Disease

Cited by 9 publications

References 2 publications

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation

Feasibility and construct validity of a Frailty index for patients with chronic kidney disease

Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait‐listing status

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