Introduction: Frailty, a pathological state of decreased physiological reserve caused by multiple factors, was initially validated in geriatric populations and emerging as a risk factor of functional decline, disability, falls, hospitalization or even death in the elderly. Available data indicate that negative consequences associated with frailty in renal transplant recipients (RTRs), including twice the odds of delayed graft function and mortality, increased risk of postoperative complications,61% increased risk of early hospital readmission and 29% increased risk of mycophenolate mofetil dose reduction. It’s important for early frailty identification in transplant recipients so that alleviate the debilitating state through effective interventions. However, frailty have not been fully investigated among RTRs. Therefore, the purpose of this paper is to identify frailty and explore its associated factors in Chinese RTRs.
Materials and Methods: Participants were recruited from a transplant follow-up center in Beijing by convenience sampling from June to October 2019. RTRs were asked to fill out the self-designed general questionnaire, Tilburg frailty indicator (TFI), Hospital Anxiety and Depression Scales (HADS), The Connor-Davidson Resilience Scale (CD-RISC), and Perceived Social Support Scale (PSSS), Pittsburgh Sleep Quality Index (PSQI).
Results and Discussion: A total of 200 RTRs were included in this study. The total score of frailty was 3 (2,6), ranging from 0 to 12.The score of physical frailty was 2 (1,3), mental frailty was 1 (0,3), and social frailty was 1 (0,1).In 82 frail patients (≥5 points), the five most common components were frequent fatigue (53%), memory loss (46.5%), weak social relationships (44.5%), anxiety (43.5%), and depression (43.5%).Univariate analysis showed significant positive correlation among frailty score with age, diseases, medications, sleep quality score, anxiety score and depression score(rs=0.167~0.452, p all<0.05),while frailty score was negatively correlated with grip strength,social support score and resilience score. Frailty score of recipients with different work status, educational level, economic burden, exercise, dialysis types and total protein were different (p all < 0.05). Multivariate analysis showed that anxiety score, sleep quality score, work status, resilience score, diseases and economic burden were into the regression equation of frailty score (p all < 0.05; standard partial regression coefficient were 0.281, 0.233, 0.229, -0.185, 0.154, and 0.136, respectively). RTRs with more anxiety, worse sleep quality, low resilience, more diseases, and high economic burden had increasing frailty.
Conclusion: In this study, the incidence of frailty in RTRs was high, and frailty was associated with anxiety, sleep quality, work status, resilience, number of diseases and economic burden. These results extend the findings on frailty of RTRs and provide a basis for the development of possible integrated interventions. During routine clinical follow-up of RTRs, frailty should be evaluated. Psychological interventions to improve resilience in RTRs care planning are recommended. Early comprehensive health education to guidance sleep and encourage lifestyle changes could be implemented, such as return to work, smoking cessation and regular exercise. Further longitudinal research to explore changes of the frailty and related factors is warranted.