Frailty and Access to Kidney Transplantation
| Autor: | Dorry L. Segev, Niraj M. Desai, Silas P. Norman, Miranda R. Jones, Mara McAdams-DeMarco, Adam W. Bingaman, Fatima Warsame, Jeremy D. Walston, Jacqueline Garonzik-Wang, Daniel C. Brennan, Christine E. Haugen, Hao Ying, Nadia M. Chu, Courtenay M. Holscher |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Epidemiology Frail Elderly medicine.medical_treatment 030232 urology & nephrology 030230 surgery Critical Care and Intensive Care Medicine Rate ratio 03 medical and health sciences Cognition 0302 clinical medicine Internal medicine medicine Humans Cognitive Dysfunction Risk factor Prospective cohort study Kidney transplantation Dialysis Transplantation Frailty business.industry Proportional hazards model Hazard ratio Original Articles medicine.disease Kidney Transplantation Confidence interval Nephrology Cognition Disorders business |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 14:576-582 |
| ISSN: | 1555-905X 1555-9041 |
| DOI: | 10.2215/cjn.12921118 |
| Popis: | BACKGROUND AND OBJECTIVES: Frailty, a syndrome distinct from comorbidity and disability, is clinically manifested as a decreased resistance to stressors and is present in up to 35% of patient with ESKD. It is associated with falls, hospitalizations, poor cognitive function, and mortality. Also, frailty is associated with poor outcomes after kidney transplant, including delirium and mortality. Frailty is likely also associated with decreased access to kidney transplantation, given its association with poor outcomes on dialysis and post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought to quantify if frail kidney transplant candidates had similar access to kidney transplantation as nonfrail candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 7078 kidney transplant candidates (2009–2018) in a three-center prospective cohort study of frailty. Fried frailty (unintentional weight loss, grip strength, walking speed, exhaustion, and activity level) was measured at outpatient kidney transplant evaluation. We estimated time to listing and transplant rate by frailty status using Cox proportional hazards and Poisson regression, adjusting for demographic and health factors. RESULTS: The mean age was 54 years (SD 13; range, 18–89), 40% were women, 34% were black, and 21% were frail. Frail participants were almost half as likely to be listed for kidney transplantation (hazard ratio, 0.62; 95% confidence interval, 0.56 to 0.69; P |
| Databáze: | OpenAIRE |
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