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      Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

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          Abstract

          Prediction models for post-kidney transplantation mortality have had limited success (C-statistics ≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, kidney transplant (KT) survival through intervention. The Short Physical Performance Battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function. SPPB performance and frailty (Fried frailty phenotype) were assessed at admission for KT in a prospective cohort of 719 KT recipients at Johns Hopkins Hospital (8/2009 to 6/2016) and University of Michigan (2/2013 to 12/2016). The independent associations between SPPB impairment (SPPB composite score ≤10) and composite score with post-KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk. The 5-year posttransplantation mortality for impaired recipients was 20.6% compared to 4.5% for unimpaired recipients (p < 0.001). Impaired recipients had a 2.30-fold (adjusted hazard ratio [aHR] 2.30, 95% confidence interval [CI] 1.12-4.74, p = 0.02) increased risk of postkidney transplantation mortality compared to unimpaired recipients. Each one-point decrease in SPPB score was independently associated with a 1.19-fold (95% CI 1.09-1.30, p < 0.001) higher risk of post-KT mortality. SPPB-derived lower extremity function is a potentially highly useful and modifiable objective measure for pre-KT risk prediction.

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          Most cited references 19

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          Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis.

          To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization. Prospective cohort study. Single hemodialysis center in Baltimore, Maryland. One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012. Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations. At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P = .046) and 2.6 times (95% CI = 1.04-6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants. Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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            Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil.

            To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test-retest reliability the authors evaluated the intraclass correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). This study provides evidence for the validity and reliability of SPPB in diverse populations.
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              Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study.

              Early detection of mobility limitations remains an important goal for preventing mobility disability. The purpose of this study was to examine the association between the Short Physical Performance Battery (SPPB) and the loss of ability to walk 400 m, an objectively assessed mobility outcome increasingly used in clinical trials. The study sample consisted of 542 adults from the InCHIANTI study aged 65 and older, who completed the 400 m walk at baseline and had evaluations on the SPPB and 400 m walk at baseline and 3-year follow-up. Multiple logistic regression models were used to determine whether SPPB scores predict the loss of ability to walk 400 m at follow-up among persons able to walk 400 m at baseline. The 3-year incidence of failing the 400 m walk was 15.5%. After adjusting for age, sex, education, body mass index, Mini-Mental State Examination, number of medical conditions, and 400 m walk gait speed at baseline, SPPB score was significantly associated with loss of ability to walk 400 m after 3 years. Participants with SPPB scores of 10 or lower at baseline had significantly higher odds of mobility disability at follow-up (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.32-8.65) compared with those who scored 12, with a graded response across the range of SPPB scores (OR = 26.93, 95% CI: 7.51-96.50; OR = 7.67, 95% CI: 2.26-26.04; OR = 8.28, 95% CI: 3.32-20.67 for SPPB < or = 7, SPPB 8, and SPPB 9, respectively). The SPPB strongly predicts loss of ability to walk 400 m. Thus, using the SPPB to identify older persons at high risk of lower body functional limitations seems a valid means of recognizing individuals who would benefit most from preventive interventions.
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                Author and article information

                Journal
                American Journal of Transplantation
                Am J Transplant
                Wiley
                16006135
                January 2018
                January 2018
                August 30 2017
                : 18
                : 1
                : 189-196
                Affiliations
                [1 ]Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
                [2 ]Department of Surgery; Johns Hopkins School of Medicine; Baltimore MD
                [3 ]Department of Physical Medicine and Rehabilitation; Johns Hopkins University School of Medicine; Baltimore MD
                [4 ]Department of Internal Medicine; Division of Nephrology; University of Michigan School of Medicine; Ann Arbor MI
                Article
                10.1111/ajt.14430
                5739948
                28710900
                © 2017

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