title: Individual Frailty Components and Mortality in Kidney Transplant Recipients.
abstract: 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.
authors: 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.
authors: Mara A
authors: MA
authors: McAdams-DeMarco
authors: Hao
authors: H
authors: Ying
authors: Israel
authors: I
authors: Olorundare
authors: Elizabeth A
authors: EA
authors: King
authors: Christine
authors: C
authors: Haugen
authors: Brian
authors: B
authors: Buta
authors: Alden L
authors: AL
authors: Gross
authors: Rita
authors: R
authors: Kalyani
authors: Niraj M
authors: NM
authors: Desai
authors: Nabil N
authors: NN
authors: Dagher
authors: Bonnie E
authors: BE
authors: Lonze
authors: Robert A
authors: RA
authors: Montgomery
authors: Karen
authors: K
authors: Bandeen-Roche
authors: Jeremy D
authors: JD
authors: Walston
authors: Dorry L
authors: DL
authors: Segev
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D004185:Disability Evaluation; D004522:Educational Status; D017079:Exercise Tolerance; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment; D018737:Hand Strength; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D066027:Transplant Recipients / Q000523:psychology*; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult