title: Frailty and early hospital readmission after kidney transplantation.
abstract: Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry-based recipient, transplant and center-level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with early KT outcomes, might serve as a novel, independent predictor of EHR in KT recipients of all ages. We measured frailty in 383 KT recipients at Johns Hopkins Hospital. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post-KT discharge. Frail KT recipients were much more likely to experience EHR (45.8% vs. 28.0%, p = 0.005), regardless of age. After adjusting for previously described registry-based risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR = 1.61, 95% CI: 1.18-2.19, p = 0.002). In addition, frailty improved EHR risk prediction by improving the area under the receiver operating characteristic curve (p = 0.01) as well as the net reclassification index (p = 0.04). Identifying frail KT recipients for targeted outpatient monitoring and intervention may reduce EHR rates.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.forename: A
authors.initials: A
authors.lastname: Law
authors.forename: M L
authors.initials: ML
authors.lastname: Salter
authors.forename: E
authors.initials: E
authors.lastname: Chow
authors.forename: M
authors.initials: M
authors.lastname: Grams
authors.forename: J
authors.initials: J
authors.lastname: Walston
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005853:Geriatrics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D007902:Length of Stay; D008137:Longitudinal Studies; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D015996:Survival Rate
keywords: Frailty; readmission; transplantation