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Frailty phenotype is associated with adverse outcomes in chronic kidney diseases (CKD) and kidney transplant (KT) patients. Data on frailty syndrome in our region is scarce. This study aimed to evaluate the prevalence of frailty, clinical and laboratory characteristics, as well as the association with disability and cognitive impairment.
A cross-sectional study included adult individuals with 5D stage CKD, eligible for KT, who underwent surgery between March 2019 and January 2021 in two Brazilian centers. Patients were assessed within 24h before transplant. Fried frailty scale was used to identify physical frailty phenotype. Basic and instrumental activities were evaluated using the Katz Index and the Lawton Scale, respectively. Cognitive assessment was performed using the Montreal Cognitive Assessment (MoCA). Biomarkers routinely collected in the pre-KT evaluation were also analyzed. Patients were divided into two groups as follows: frail or pre-frail (Group F) and non-frail (Group NF).
The sample consisted of 82 patients, of whom 30 (36.6%) were considered non-frail, 28 (34.1%) pre-frail, and 24 (29.3%) frail. In the Fried Scale Instruments Group F exhibited significantly higher levels of weakness (47% vs. 0%, p<0.001), exhaustion (38% vs. 3.3%, p<0.001), and slowness (37% vs. 0%, p<0.001); however, no significant differences were observed in terms of weight loss and physical activity. There were no differences between the groups regarding gender (80% male), race (87% non-Caucasian), age (49±15 years), body mass index (24.9±4.3 Kg/m2), time on dialysis (median of 38 months), type of donor (89% deceased donor), CKD etiology (24% diabetes, 22% hypertension, and 18% glomerulopathies), type of dialysis, or educational level of the patient. Group F had a higher percentage of hypertensive individuals (90% vs. 70%, p=0.018), with rheumatic diseases (15% vs. 0%, p=0.024), lower creatinine (7 vs. 9 mg/dL, p=0.044), and lower hemoglobin levels (11.9±2.7 vs. 13.4±1.8 g/dL, p=0.005). Compared to non-frail patients (Group NF), patients in Group F (frail and pre-frail) had worse performance in basic activities (32% with some dependence vs. 0%, p<0.001) and instrumental activities of daily living (82% with some dependence vs. 57%, p=0.014), as well as greater cognitive impairment (65% vs. 37%, p=0.037).
The prevalence of frailty or pre-frailty was high in this sample. The frailty phenotype was associated with hypertension, rheumatic diseases, lower creatinine and hemoglobin levels, as well as greater dependence on basic and instrumental activities of daily living, along with more significant cognitive impairment.