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Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study

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Abstract

Background

Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx.

Methods

In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3–5 defines frailty, 2 is intermediate, and 0–1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods.

Results

Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001).

Conclusions

There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil

    Milena dos Santos Mantovani & Nyara Coelho de Carvalho

  2. Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil

    Ricardo de Souza Cavalcante, Gabriel Berg de Almeida, Julhiany de Fátima da Silva & Ricardo Augusto Monteiro de Barros Almeida

  3. Internal Medicine Department, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil

    Marcos Ferreira Minicucci & Luis Gustavo Modelli de Andrade

  4. Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil

    Nara Aline Costa

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Contributions

Conceptualization and methodology: MSM, MFM, LGMA, RSC, GBA, NAC, JFS, RAMBA; Data collection: MSM, NCC, RSC, GBA, RAMBA; Formal analysis: MFM, LGMA; Writing the initial draft: MSM, MFM, NAC, RAMBA; Supervision: RAMBA; Funding acquisition: RAMBA; All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Ricardo Augusto Monteiro de Barros Almeida.

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Conflict of interest

The authors of this study declare no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The Institutional Review Board of Botucatu Medical School approved this study (IRB approval number: CAAE 59232316.2.0000.5411). All participants provided written informed consent.

Funding

This work was supported by the São Paulo Research Foundation (FAPESP) (2016/24745-3) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES) (Finance Code 001).

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dos Santos Mantovani, M., Coelho de Carvalho, N., Ferreira Minicucci, M. et al. Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study. J Nephrol 35, 2341–2349 (2022). https://doi.org/10.1007/s40620-022-01436-4

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