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Abstract
Introduction: Frailty is a determinant in the health assessment of renal transplant donors and recipients. It is linked to increased surgical risk and poorer postoperative outcomes. However, the impact of frailty in kidney donor candidates (KDC) has yet to be investigated.
Objectives: To describe the socio-demographic and clinical characteristics of a cohort of renal donor candidates in Spain and to analyse the relationship between frailty, suitability for donation, and surgical complications.
Material and Method: A retrospective cohort study that included KDC was evaluated between April 2020 and April 2024 at the Hospital del Mar in Barcelona. Socio-demographic, clinical, and frailty data were collected; statistical analyses included Chi-square and T-Student tests (p<0.05).
Results: A total of 231 KDCs completed the first phase of evaluation. The majority were women (61.9%), with a mean age of 56.31±12.95 years and a medium-high or high socioeconomic level (76.62%). According to the Fried scale, 25% (n=27) and 0.93% (n=1) of the KDC had pre-frailty and frailty, respectively, while no frailty was undetected. 30.49% (n=75) of KDC were accepted for donation. Postoperative complications included dehiscence, bleeding, and seroma (n=1; 1.33% each).
Conclusions: This study highlights the low prevalence of frailty among KDC and its limited association with surgical complications. However, cardiovascular risk factors remain key in the evaluation. Further research is needed to improve the safety of the donation process.
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Copyright (c) 2024 Maria Carreras-Carbonell, GUILLERMO PEDREIRA ROBLES, Anna Bach Pascual, María José Pérez Sáez, Dolores Redondo Pachón, Marta Crespo, Eva Padrosa
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References
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- Pérez-Sáez MJ, Gutiérrez-Dalmau Á, Moreso F, Rodríguez Mañas L, Pascual J. Frailty and kidney transplant candidates. Nefrologia. 2021;41(3):237-43.
- Haugen CE, Chu NM, Ying H, Warsame F, Holscher CM, Desai NM, Jones MR, Norman SP, Brennan DC, Garonzik-Wang J, Walston JD, Bingaman AW, Segev DL, McAdams-DeMarco M. Frailty and Access to Kidney Transplantation. Clin J Am Soc Nephrol. 2019;14(4):576-82.
- McAdams-DeMarco MA, Thind AK, Nixon AC, Woywodt A. Frailty assessment as part of transplant listing: yes, no or maybe? Clin Kidney J. 2022;16(5):809-16.
- Birkelbach O, Mörgeli R, Spies C, Olbert M, Weiss B, Brauner M, et al. Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - a retrospective observational study. BMC Anesthesiol. 2019;19(1):204.
- Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, et al. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020;104(4S1 Suppl 1):S11-103.
- McIsaac DI, MacDonald DB, Aucoin SD. Frailty for Perioperative Clinicians: A Narrative Review. Anesth Analg. 2020;130(6):1450-60.
- Rose M, Pan H, Levinson MR, Staples M. Can frailty predict complicated care needs and length of stay? Intern Med J. 2014;44(8):800-5.
- Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing. 2019;48(3):388-94.
- Nidadavolu LS, Ehrlich AL, Sieber FE, Oh ES. Preoperative Evaluation of the Frail Patient. Anesth Analg. 2020;130(6):1493-503.
- Poh AWY, Teo SP. Utility of Frailty Screening Tools in Older Surgical Patients. Ann Geriatr Med Res. 2020;24(2):75-82.
- Pedreira-Robles G, Morín-Fraile V, Bach-Pascual A, Redondo-PachónD, Crespo M, Garcimartín P. Necesidades asistenciales durante el estudio de personas candidatas a donantes de riñón. Enferm Nefrol. 2022;25(2):169-81
- Kidney Disease Improving Global Outcomes (KDIGO). Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Official Journal of The Transplantation Society & International Liver Transplantation Society. 2017;101(8S-1).
- Colls Cristina MM, García-Altés A. Un índice de privación para reformar el modelo de financiación de la atención primaria en Cataluña. Gac Sanit. 2020;34(1):44-50.
- Acosta-Benitoa MA, Martín-Lesende I. Fragilidad en atención primaria: diagnóstico y manejo multidisciplinar. Aten Prim. 2022;54(9):102395.
- Lemus Barriosa GA, Morales Benavidez DC, López Salazar AM, Henaoc V, González-Robledo G. Evaluación de la fragilidad de la enfermedad cardiovascular: Un reto necesario. Rev Colomb Cardiol. 2020;27(4):283-93.
- Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Maryland State Medical Journal. 1965;14:61-5.
- Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3);179-86.
- Rota-Musoll L, Brigidi S, Molina-Robles E, Oriol-Vila E, Perez-Oller L, Subirana-Casacuberta M. An intersectional gender analysis in kidney transplantation: women who donate a kidney. BMC Nephrol. 2021;22(1):59.
- Basiri A, Taheri M, Khoshdel A, Golshan S, Mohseni-Rad H, Borumandnia N, et al. Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant. Int J Equity Health. 2020;19(1):79.
- Katz-Greenberg G, Shah S. Sex and Gender Differences in Kidney Transplantation. Semin Nephrol. 2022;42(2):219-29.
- Aranceta-Bartrina J, Pérez-Rodrigo C, Alberdi-Aresti G, Ramos-Carrera N, Lázaro-Masedo S. Prevalence of General Obesity and Abdominal Obesity in the Spanish Adult Population (Aged 25-64 Years) 2014-2015: The ENPE Study. Rev Esp Cardiol. 2016;69(6):579-87.
- Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337.
- Pintó X, Trias Vilagut F, Rius Taruella J, Mairal Sallán E. Actitud clínica ante la dislipemia en pacientes con elevado riesgo cardiovascular en España. Estudio ALMA. Aten Primaria. 2018;50(1):35-43.
- Rota-Musoll L, Subirana-Casacuberta M, Oriol-Vila E, Homs-Del Valle M, Molina-Robles E, Brigidi S. The experience of donating and receiving a kidney: A systematic review of qualitative studies. J Ren Care. 2020;46(3):169-84.
- Schopmeyer L, El Moumni M, Nieuwenhuijs-Moeke GJ, Berger SP, Bakker SJL, Pol RA. Frailty has a significant influence on postoperative complications after kidney transplantation-a prospective study on short-term outcomes. Transpl Int. 2019;32(1):66-74.
- Dos Santos Mantovani M, Coelho de Carvalho N, Archangelo TE, Modelli de Andrade LG, Pires Ferreira Filho S, de Souza Cavalcante R, et al. Frailty predicts surgical complications after kidney transplantation. A propensity score matched study. PLoS One. 2020;15(2):e0229531.
- Oviedo-Briones M, Rodríguez-Laso Á, Carnicero JA, Gryglewska B, Sinclair AJ, Landi F, et al. The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project. J
- Oviedo-Briones M, Laso ÁR, Carnicero JA, Cesari M, Grodzicki T, Gryglewska B, et al. A Comparison of Frailty Assessment Instruments in Different Clinical and Social Care Settings: The Frailtools Project. J Am Med Dir Assoc. 2021;22(3):607.e7-607.e12.
- Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Eur J Intern Med. 2016;31:3-10.
- Pritchard JM, Kennedy CC, Karampatos S, Ioannidis G, Misiaszek B, Marr S, et al. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic. BMC Geriatr. 2017;17(1):264.
References
Muñoz-Redondo E, Morgado-Pérez A, Pérez-Sáez MJ, Pascual J, Tejero-Sánchez M, Curbelo YG, et al. New perspectives on frailty in light of the Global Leadership Initiative on Malnutrition, the Global Leadership Initiative on Sarcopenia, and the WHO’s concept of intrinsic capacity: A narrative review. Maturitas. 2023;177:107799.
Pérez-Sáez MJ, Gutiérrez-Dalmau Á, Moreso F, Rodríguez Mañas L, Pascual J. Frailty and kidney transplant candidates. Nefrologia. 2021;41(3):237-43.
Haugen CE, Chu NM, Ying H, Warsame F, Holscher CM, Desai NM, Jones MR, Norman SP, Brennan DC, Garonzik-Wang J, Walston JD, Bingaman AW, Segev DL, McAdams-DeMarco M. Frailty and Access to Kidney Transplantation. Clin J Am Soc Nephrol. 2019;14(4):576-82.
McAdams-DeMarco MA, Thind AK, Nixon AC, Woywodt A. Frailty assessment as part of transplant listing: yes, no or maybe? Clin Kidney J. 2022;16(5):809-16.
Birkelbach O, Mörgeli R, Spies C, Olbert M, Weiss B, Brauner M, et al. Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - a retrospective observational study. BMC Anesthesiol. 2019;19(1):204.
Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, et al. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation. 2020;104(4S1 Suppl 1):S11-103.
McIsaac DI, MacDonald DB, Aucoin SD. Frailty for Perioperative Clinicians: A Narrative Review. Anesth Analg. 2020;130(6):1450-60.
Rose M, Pan H, Levinson MR, Staples M. Can frailty predict complicated care needs and length of stay? Intern Med J. 2014;44(8):800-5.
Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing. 2019;48(3):388-94.
Nidadavolu LS, Ehrlich AL, Sieber FE, Oh ES. Preoperative Evaluation of the Frail Patient. Anesth Analg. 2020;130(6):1493-503.
Poh AWY, Teo SP. Utility of Frailty Screening Tools in Older Surgical Patients. Ann Geriatr Med Res. 2020;24(2):75-82.
Pedreira-Robles G, Morín-Fraile V, Bach-Pascual A, Redondo-PachónD, Crespo M, Garcimartín P. Necesidades asistenciales durante el estudio de personas candidatas a donantes de riñón. Enferm Nefrol. 2022;25(2):169-81
Kidney Disease Improving Global Outcomes (KDIGO). Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Official Journal of The Transplantation Society & International Liver Transplantation Society. 2017;101(8S-1).
Colls Cristina MM, García-Altés A. Un índice de privación para reformar el modelo de financiación de la atención primaria en Cataluña. Gac Sanit. 2020;34(1):44-50.
Acosta-Benitoa MA, Martín-Lesende I. Fragilidad en atención primaria: diagnóstico y manejo multidisciplinar. Aten Prim. 2022;54(9):102395.
Lemus Barriosa GA, Morales Benavidez DC, López Salazar AM, Henaoc V, González-Robledo G. Evaluación de la fragilidad de la enfermedad cardiovascular: Un reto necesario. Rev Colomb Cardiol. 2020;27(4):283-93.
Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Maryland State Medical Journal. 1965;14:61-5.
Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3);179-86.
Rota-Musoll L, Brigidi S, Molina-Robles E, Oriol-Vila E, Perez-Oller L, Subirana-Casacuberta M. An intersectional gender analysis in kidney transplantation: women who donate a kidney. BMC Nephrol. 2021;22(1):59.
Basiri A, Taheri M, Khoshdel A, Golshan S, Mohseni-Rad H, Borumandnia N, et al. Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant. Int J Equity Health. 2020;19(1):79.
Katz-Greenberg G, Shah S. Sex and Gender Differences in Kidney Transplantation. Semin Nephrol. 2022;42(2):219-29.
Aranceta-Bartrina J, Pérez-Rodrigo C, Alberdi-Aresti G, Ramos-Carrera N, Lázaro-Masedo S. Prevalence of General Obesity and Abdominal Obesity in the Spanish Adult Population (Aged 25-64 Years) 2014-2015: The ENPE Study. Rev Esp Cardiol. 2016;69(6):579-87.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337.
Pintó X, Trias Vilagut F, Rius Taruella J, Mairal Sallán E. Actitud clínica ante la dislipemia en pacientes con elevado riesgo cardiovascular en España. Estudio ALMA. Aten Primaria. 2018;50(1):35-43.
Rota-Musoll L, Subirana-Casacuberta M, Oriol-Vila E, Homs-Del Valle M, Molina-Robles E, Brigidi S. The experience of donating and receiving a kidney: A systematic review of qualitative studies. J Ren Care. 2020;46(3):169-84.
Schopmeyer L, El Moumni M, Nieuwenhuijs-Moeke GJ, Berger SP, Bakker SJL, Pol RA. Frailty has a significant influence on postoperative complications after kidney transplantation-a prospective study on short-term outcomes. Transpl Int. 2019;32(1):66-74.
Dos Santos Mantovani M, Coelho de Carvalho N, Archangelo TE, Modelli de Andrade LG, Pires Ferreira Filho S, de Souza Cavalcante R, et al. Frailty predicts surgical complications after kidney transplantation. A propensity score matched study. PLoS One. 2020;15(2):e0229531.
Oviedo-Briones M, Rodríguez-Laso Á, Carnicero JA, Gryglewska B, Sinclair AJ, Landi F, et al. The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project. J
Oviedo-Briones M, Laso ÁR, Carnicero JA, Cesari M, Grodzicki T, Gryglewska B, et al. A Comparison of Frailty Assessment Instruments in Different Clinical and Social Care Settings: The Frailtools Project. J Am Med Dir Assoc. 2021;22(3):607.e7-607.e12.
Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Eur J Intern Med. 2016;31:3-10.
Pritchard JM, Kennedy CC, Karampatos S, Ioannidis G, Misiaszek B, Marr S, et al. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic. BMC Geriatr. 2017;17(1):264.