Thind Amarpreet K, Levy Shuli, Wellsted David, Willicombe Michelle, Brown Edwina A
Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom.
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Front Nephrol. 2023 Jan 17;2:1058765. doi: 10.3389/fneph.2022.1058765. eCollection 2022.
Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this. We present a secondary analysis of the Edmonton Frail Scale (EFS) and its relationship with patient experience scores.
The KTOP study is a single centre, prospective study, which began in October 2019. All ESKD patients aged ≥60 considered for transplantation at Imperial College Renal and Transplant Centre were eligible. Frailty was assessed using the EFS and 5 questionnaires assessed patient experience and quality of life (QoL) (Short Form-12(v2), Palliative Care Outcome Scale-Symptoms Renal, Depression Patient Health Questionnaire-9, Illness Intrusiveness Ratings Scale, Renal Treatment Satisfaction Questionnaire). The EFS was divided into 4 subdomains (psychosocial, physical function, medical status, and general health) and then compared with the questionnaire scores.
210 patients have been recruited (aged 60-78), 186 of whom completed EFS assessments. 118 (63.4%) participants were not frail, 36 (19.4%) vulnerable, and 32 (17.2%) were frail. Worse frailty scores were associated with poorer patient experience and QoL scores across all questionnaires. Severe deficits in the EFS psychosocial subdomain showed a statistically significant association with higher depression screen scores (coefficient 4.9, 95% CI 3.22 to 6.59), lower physical (coefficient -4.35, 95% CI -7.59 to -1.12) and mental function scores (coefficient -8.33, 95% CI -11.77 to -4.88) from the Short Form-12(v2), and lower renal treatment satisfaction scores (coefficient -5.54, 95% CI -10.70 to -0.37). Deficits in the physical function and medical status EFS subdomians showed some association with patient experience scores.
In the KTOP study cohort at recruitment vulnerable and frail candidates reported worse QoL and patient experiences. Severe deficits in the psychosocial subdomains of the EFS showed a strong association with patient experience and QoL, whilst physical function and medical status deficits showed a lesser association. This has highlighted specific EFS domains that may be suitable for targeted interventions to improve experiences and optimise outcomes.
患有终末期肾病（ESKD）的老年人易患衰弱症，这会影响临床和体验结果。随着老年人肾移植数量的增加，为指导决策，有必要更好地了解患者的体验。老年人肾移植（KTOP）：衰弱对结果的影响研究旨在探索这一问题。我们对埃德蒙顿衰弱量表（EFS）及其与患者体验评分的关系进行了二次分析。
KTOP研究是一项单中心前瞻性研究，于2019年10月开始。所有年龄≥60岁、在帝国理工学院肾脏与移植中心考虑进行移植的ESKD患者均符合条件。使用EFS评估衰弱情况，并用5份问卷评估患者体验和生活质量（QoL）（简短形式-12（v2）、姑息治疗结果量表-肾脏症状、患者健康问卷-9抑郁量表、疾病侵扰评定量表、肾脏治疗满意度问卷）。将EFS分为4个子领域（心理社会、身体功能、医疗状况和总体健康），然后与问卷得分进行比较。
已招募210名患者（年龄60 - 78岁），其中186名完成了EFS评估。118名（63.4%）参与者无衰弱，36名（19.4%）易衰弱，32名（17.2%）衰弱。在所有问卷中，较差的衰弱评分与较差的患者体验和QoL评分相关。EFS心理社会子领域的严重缺陷与较高的抑郁筛查评分（系数4.9，95%置信区间3.22至6.59）、简短形式-12（v2）中较低的身体（系数 - 4.35，95%置信区间 - 7.59至 - 1.12）和心理功能评分（系数 - 8.33，95%置信区间 - 11.77至 - 4.88）以及较低的肾脏治疗满意度评分（系数 - 5.54，95%置信区间 - 10.70至 - 0.37）存在统计学显著关联。身体功能和医疗状况EFS子领域的缺陷与患者体验评分存在一定关联。
在KTOP研究队列招募时，易衰弱和衰弱的候选人报告的生活质量和患者体验较差。EFS心理社会子领域的严重缺陷与患者体验和生活质量密切相关，而身体功能和医疗状况缺陷的关联较小。这突出了EFS的特定领域，可能适用于针对性干预，以改善体验并优化结果。
