Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.
Internal Medicine Department, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil.
J Nephrol. 2022 Dec;35(9):2341-2349. doi: 10.1007/s40620-022-01436-4. Epub 2022 Sep 1.
Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx.
In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods.
Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001).
There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.
虚弱与肾移植（KTx）后多种不良结局相关。然而，关于 KTx 后虚弱状态及其组成部分的转变，信息有限。本研究旨在评估 KTx 后 12 个月内身体虚弱表型及其组成部分的转变。
在这项前瞻性单中心队列研究中，我们在 KTx 入院时和 KTx 后 12 个月测量身体虚弱表型（PFP）及其组成部分。评估包括五个组成部分：虚弱（按性别和体重指数四分位数分析的握力）、身体活动（根据明尼苏达州休闲时间身体活动问卷计算的 kcals/周）、疲惫（使用流行病学研究中心抑郁量表进行自我报告）、步态速度（根据性别和身高特异性截止值行走 15 英尺所需的时间）和非有意体重减轻（自我报告的过去一年中无意体重减轻>10 磅）。疲惫和身体活动成分在巴西人群中得到验证。根据其存在或不存在，每个成分得分为 0 或 1，3-5 分的 PFP 评分定义为虚弱，2 分为中等，0-1 分为非虚弱。我们使用 McNemar 和 Wilcoxon 检验比较两个时期的身体虚弱表型及其组成部分。
在纳入的 87 例患者中，16.1%被归类为虚弱，20.7%为中度虚弱，63.2%为非虚弱。64 例患者纳入虚弱转变分析。在 KTx 入院时，15.6%的患者被定义为虚弱，而在 KTx 后 12 个月时，4.7%的患者为虚弱（p=0.023）。在身体虚弱表型组成部分中，KTx 后 12 个月体重减轻类别的患者比例明显低于 KTx 时（6.3%比 34.4%，p<0.001）。
KTx 后 12 个月随访结束时，虚弱患者的患病率降低了 69.9%。在虚弱的组成部分中，体重减轻有了显著改善。
