Individual Frailty Components and Mortality in Kidney Transplant Recipients
Individual Frailty Components and Mortality in Kidney Transplant Recipients
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DOI：
10.1097/tp.0000000000001546
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发表时间：
2017-09-01
期刊：
影响因子：
6.2
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
McAdams-DeMarco, Mara A.;Ying, Hao;Segev, Dorry L.
背景虚弱增加了肾移植（KT）受者的早期再入院和死亡风险。虽然虚弱代表了高风险的状态，这一人群，虚弱的相关性，5个虚弱组件的模式，并与这些patterns.Methods相关的风险六百六十三KT收件人参加了一项队列研究移植虚弱（12/2008-8/2015）。测量虚弱、日常生活活动（ADL）/工具性ADL（IADL）残疾、流行病学研究中心抑郁量表抑郁、教育和健康相关生活质量（HRQOL）。我们使用多项回归来确定脆弱的相关性。我们使用调整后的考克斯比例风险模型确定了5个组成部分中哪些模式与死亡率相关。年龄较大的受者（调整后的患病率[PR]，2.22; 95%置信区间[CI]，1.21-4.07）更可能是虚弱的。唯一与虚弱独立相关的其他因素是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（PR，3.10; 95% CI，1.30-7.36）和低HRQOL（一般/差：PR，3.71; 95% CI，1.48-9.31）。最常见的模式是握力差，体力活动少，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。KT受者出现疲乏和行走速度减慢（风险比= 2.43; 95% CI，1.17-5.03）和握力差、疲惫和步行速度减慢（危险比2.61; 95% CI 1.14-5.97）。结论年龄是KT受者中唯一与虚弱相关的常规因素;然而，临床实践中很少测量的因素，即HRQOL，IADL残疾和抑郁症状，与虚弱有显著相关性。可能需要重新定义虚弱表型以改善KT接受者的风险分层。
Background 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.Methods 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.Results 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.Conclusions 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.