Frailty in kidney transplant candidates: a comparison between physical frailty phenotype and FRAIL scales

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

Download Full-text

Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Nutrients ◽

10.3390/nu13072151 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2151

Author(s):

Berna Rahi ◽

Hermine Pellay ◽

Virginie Chuy ◽

Catherine Helmer ◽

Cecilia Samieri ◽

...

Keyword(s):

Older Adults ◽

Dairy Product ◽

Food Group ◽

Community Dwelling ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cross Sectional ◽

Sectional Analysis ◽

Community Dwelling Older Adults

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

Download Full-text

Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

Urologia Internationalis ◽

10.1159/000516678 ◽

2021 ◽

pp. 1-8

Author(s):

Dominik Promny ◽

Theresa Hauck ◽

Aijia Cai ◽

Andreas Arkudas ◽

Katharina Heller ◽

...

Keyword(s):

Wound Healing ◽

Kidney Transplantation ◽

Postoperative Complications ◽

Kidney Transplant ◽

Interdisciplinary Approach ◽

Wound Complications ◽

Obese Patients ◽

Patient Cohort ◽

Transplant Candidates ◽

Stage Renal Disease

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

Download Full-text

Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02025-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashwin Radhakrishnan ◽

Luke C. Pickup ◽

Anna M. Price ◽

Jonathan P. Law ◽

Kirsty C. McGee ◽

...

Keyword(s):

Confidence Interval ◽

Renal Disease ◽

Kidney Transplant ◽

End Stage Renal Disease ◽

Microvascular Dysfunction ◽

Left Ventricular ◽

Coronary Microvascular Dysfunction ◽

Transplant Candidates ◽

Stage Renal Disease ◽

End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

Download Full-text