Even mild frailty increases the risk for death in kidney transplant recipients, a new study finds.
The Physical Frailty Phenotype score assigns 1 point each for unintentional weight loss (9.9 pounds or more during the past year), poor grip strength, exhaustion, low activity, and slowed walking speed.
Among 296 patients evaluated for kidney transplantation, investigators found that only 30% scored 0, indicating no frailty. Another 43% had a score of 1 and 27% had a score of 2 or more.
In multivariable analyses, a frailty score of 1 vs 0 was significantly associated with 3.5-fold increased risk for death after kidney transplantation, Julio Pascual, MD, of Hospital del Mar in Barcelona, Spain, and colleagues reported in Clinical Kidney Journal. In this cohort, recipients who presented with 1 frailty criterion most often complained of weakness (66.1%), followed by weight loss (15.7%), exhaustion (15%), slow walking speed (1.6%), and low physical activity (0.8%).
Different definitions of robustness have been used for patients with chronic kidney disease, with some previous studies considering a frailty score of 1 as “robust.”
According to Dr Pascual’s team, “these patients do not seem to die as early as those who were frailer, but still, their risk of death is higher than the ones who did not score for any [physical frailty phenotype] criteria before transplantation.”
A univariable analysis showed that 1-year graft loss (but not death-censored graft loss) occurred in a significantly greater proportion of patients with a frailty score of 1 vs 0 (21.5% vs 10.6%).
Recipients with peripheral vascular disease had a significant 9.0-fold increased risk for death, the investigators also reported. Significantly greater proportions of patients with a frailty score of 2 or more were female or had cerebrovascular disease.
José Pérez-Sáez M, Arias-Cabrales CE, Redondo-Pachón D, et al. Increased mortality after kidney transplantation in mildly frail recipients. Clinical Kidney J. doi:10.1093/ckj/sfac159