McAdams-DeMarco Mara A, Ying Hao, Olorundare Israel, King Elizabeth A, Haugen Christine, Buta Brian, Gross Alden L, Kalyani Rita, Desai Niraj M, Dagher Nabil N, Lonze Bonnie E, Montgomery Robert A, Bandeen-Roche Karen, Walston Jeremy D, Segev Dorry L
1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 3 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4 Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2017 Sep;101(9):2126-2132. doi: 10.1097/TP.0000000000001546.
Frailty increases early hospital readmission and mortality risk among kidney transplantation (KT) recipients. Although frailty represents a high-risk state for this population, the correlates of frailty, the patterns of the 5 frailty components, and the risk associated with these patterns are unclear.
Six hundred sixty-three KT recipients were enrolled in a cohort study of frailty in transplantation (12/2008-8/2015). Frailty, activities of daily living (ADL)/instrumental ADL (IADL) disability, Centers for Epidemiologic Studies Depression Scale depression, education, and health-related quality of life (HRQOL) were measured. We used multinomial regression to identify frailty correlates. We identified which patterns of the 5 components were associated with mortality using adjusted Cox proportional hazards models.
Frailty prevalence was 19.5%. Older recipients (adjusted prevalence ratio [PR], 2.22; 95% confidence interval [CI], 1.21-4.07) were more likely to be frail. The only other factors that were independently associated with frailty were IADL disability (PR, 3.22; 95% CI, 1.72-6.06), depressive symptoms (PR, 11.31; 95% CI, 4.02-31.82), less than a high school education (PR, 3.10; 95% CI, 1.30-7.36), and low HRQOL (fair/poor: PR, 3.71; 95% CI, 1.48-9.31). The most common pattern was poor grip strength, low physical activity, and slowed walk speed (19.4%). Only 2 patterns of the 5 components emerged as having an association with post-KT mortality. KT recipients with exhaustion and slowed walking speed (hazards ratio = 2.43; 95% CI, 1.17-5.03) and poor grip strength, exhaustion, and slowed walking speed (hazard ratio, 2.61; 95% CI, 1.14-5.97) were at increased mortality risk.
Age was the only conventional factor associated with frailty among KT recipients; however, factors rarely measured as part of clinical practice, namely, HRQOL, IADL disability, and depressive symptoms, were significant correlates of frailty. Redefining the frailty phenotype may be needed to improve risk stratification for KT recipients.
虚弱会增加肾移植（KT）受者早期再次入院和死亡风险。尽管虚弱是该人群的高危状态，但虚弱的相关因素、5种虚弱成分的模式以及与这些模式相关的风险尚不清楚。
663名KT受者纳入了一项移植虚弱队列研究（2008年12月 - 2015年8月）。测量了虚弱、日常生活活动（ADL）/工具性日常生活活动（IADL）残疾、流行病学研究中心抑郁量表抑郁、教育程度以及健康相关生活质量（HRQOL）。我们使用多项回归来确定虚弱的相关因素。我们使用调整后的Cox比例风险模型确定5种成分的哪些模式与死亡率相关。
虚弱患病率为19.5%。年龄较大的受者（调整后的患病率比[PR]，2.22；95%置信区间[CI]，1.21 - 4.07）更有可能虚弱。与虚弱独立相关的唯一其他因素是IADL残疾（PR，3.22；95%CI，1.72 - 6.06）、抑郁症状（PR，11.31；95%CI，4.02 - 31.82）、高中以下学历（PR，3.10；95%CI，1.30 - 7.36）以及低HRQOL（一般/差：PR，3.71；95%CI，1.48 - 9.31）。最常见的模式是握力差、身体活动少和步行速度慢（19.4%）。5种成分中只有2种模式与KT后死亡率相关。存在疲惫和步行速度慢的KT受者（风险比 = 2.43；95%CI，1.17 - 5.03）以及握力差、疲惫和步行速度慢的受者（风险比，2.61；95%CI，1.14 - 5.97）死亡风险增加。
年龄是KT受者中与虚弱相关的唯一传统因素；然而，很少作为临床实践一部分进行测量的因素，即HRQOL、IADL残疾和抑郁症状，是虚弱的重要相关因素。可能需要重新定义虚弱表型以改善KT受者的风险分层。
