Member's paper - Kidney Health Education and Research Group

Abstract

PHYSICAL FUNCTION IMPAIRMENT AMONG KIDNEY TRANSPLANT RECIPIENTS AND PATIENTS ON DIALYSIS

Ghazi, W., Tang, E., Edwards, N., Gyatso, K., Siddiqui, R., El-Dassouki, N., Jamil, F., Afzal, A., Ahmadzadeh, G., Novak, M., Mucsi, I.

2021

European Society for Organ Transplant (ESOT)

Full Abstract
Background: Kidney transplantation (KT) improves physical function (PF) compared to dialysis. However, kidney transplant recipients (KTR) are increasingly elderly and have multiple comorbidities, potentially impacting their PF. We compare the prevalence of PF impairment (PFi) between patients on dialysis and KTR. Methods: A cross-sectional sample of adults treated with renal replacement therapy (RRT: KT or dialysis) in Toronto, Canada completed the Patient Reported Outcome Measurement Information System (PROMIS) PF item bank (either short form [4 items] or computer adaptive test) and a sociodemographic questionnaire. PROMIS PF is scored on a T-score metric with a mean of 50 (US population mean) and a SD of 10. Severe PFi is defined as a PROMIS PF T-score <35. Association between RRT and PFi was assessed in multivariable regression models. Covariables included: age, sex, ethnicity, Charlson Comorbidity Index (CCI), hemoglobin (hb), and albumin. Results: Of the 711 participants, 393 were KTR and 318 were on dialysis. The mean age (SD) was 57 (17), majority male (430[60%]). Mean (SD) PF score for KTR vs dialysis was 48.2 (10) vs 37.2 (9) (p<0.001). Severe PFi was more frequent in patients on dialysis compared to KTR (43% vs 11%, p<0.001). 82% of patients on dialysis vs 36% of KTR had a PF score <45. PF was correlated with age (r=-0.42), albumin (r=0.44), CCI (r=-0.29) and hb (r=0.38), p<0.001 for all. In a multivariable adjusted linear regression model, KT was associated with higher PF score (B=4.78, p<0.001; 95% CI: 2.69–6.88). In this model, predictors of PF were age, sex, hb, and CCI. In a logistic regression, KT was associated with lower odds of severe PFi (OR: 0.52, p=0.034; CI: 0.29–0.95). Conclusions: PFi was less frequent in KTR compared to patients on dialysis, but a large proportion of KTR had T scores <45 indicating noticeable PFi compared to the US general population. In future research we will assess the impact of physical rehabilitation in these patients.

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