Fragilidade como preditora de desfechos no transplante renal. Estudo de coorte de 12 meses
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2022-07-01
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Universidade Estadual Paulista (Unesp)
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Introdução: Nos dias atuais, o transplante renal (TxR) é a melhor alternativa terapêutica para os pacientes em estágio final da doença renal crônica. Para que o TxR seja realizado, são definidas avaliações criteriosas com o intuito de minimizar desfechos desfavoráveis. Apesar dos critérios clássicos para realização do TxR estarem bem estabelecidos na literatura, a fragilidade, uma medida de reserva fisiológica, vem se mostrando como ferramenta bastante aplicável e recomendada para predizer desfechos relevantes nesta população. Contudo, não foram identificados estudos nacionais utilizando esta ferramenta. Do mesmo modo, poucos estudos avaliaram a evolução da fragilidade e seus componentes após o TxR, gerando resultados conflitantes. Objetivo: Avaliar a fragilidade como preditora de desfechos 12 meses após o TxR, assim como a sua evolução. Metodologia: Foi realizado um estudo prospectivo observacional que incluiu indivíduos com idade ≥ 18 anos, submetidos ao TxR no Hospital das Clínicas da Faculdade de Medicina de Botucatu entre março de 2017 e março de 2018. Foram excluídos indivíduos com transplantes combinados e os que possuíam critérios que não permitissem a aplicação do escore de fragilidade. Todos os participantes foram avaliados na admissão para a cirurgia do TxR, momento em que foram coletados dados demográficos, clínicos, antropométricos, laboratoriais e sobre o TxR. Nesse mesmo momento, também foi calculado o escore de fragilidade, de acordo com Fried et al. Doze meses após o TxR, foram coletados dados relativos aos desfechos rejeição aguda do enxerto, perda do enxerto, taxa de filtração glomerular estimada final e óbito, além do escore de fragilidade. Resultados: Foram incluídos no estudo 87 pacientes. Desses, 16,1% foram classificados como frágeis pré-TxR. Não houve significância estatística na associação entre a fragilidade pré-TxR e os desfechos estudados após 12 meses. Houve redução de 69,9% (15,6% versus 4,7%; p = 0,023) na proporção de indivíduos frágeis ao final do período de seguimento de 12 meses após o TxR. Dentre os componentes da fragilidade, a perda de peso foi o componente que demonstrou melhora estatisticamente significante neste período (34,4% versus 6,3%; p < 0,001). Mantiveram-se não frágeis 84,4% dos pacientes, nenhum paciente evoluiu para a fragilidade, 4,7% dos pacientes permaneceram frágeis e 10,9% deixaram de ser frágeis no período estudado. Conclusão: A fragilidade não foi capaz de predizer os desfechos rejeição aguda do enxerto, perda do enxerto, taxa de filtração glomerular estimada final e óbito na casuística e período de seguimento avaliados. Houve redução de 69,9% na proporção de indivíduos frágeis ao final do período de seguimento de 12 meses após o TxR. Dentre os componentes da fragilidade, a perda de peso foi o componente que demonstrou melhora estatisticamente significante neste período.
Introduction: Today, kidney transplantation (KTx) is the best therapeutic alternative for end-stage chronic kidney disease patients. During the screening of patients for KTx, careful assessments are performed to minimize unfavorable outcomes. Although the classic eligibility criteria for KTx are well established in the literature, frailty, a measure of the physiological reserve, has been used for predicting relevant outcomes for this population. However, we did not identify studies that used this tool in a Brazilian series. Similarly, few studies have evaluated the transition of frailty state and its components after KTx. Objective: To assess frailty as a predictor of outcomes and evaluate the transitions in physical frailty phenotype 12 months after KTx. Methods: We conducted a prospective and longitudinal study that included patients aged 18 years who underwent KTx between March 2017 and March 2018. We excluded patients with combined transplants and those who had criteria that did not allow the application of the frailty score. All patients were evaluated at the time of admission for KTx. Demographic, clinical, anthropometric, laboratory, and KTx data were collected from medical records and interviews with the patients. The frailty score was simultaneously calculated. Twelve months after KTx, we evaluated the outcomes of acute graft rejection, graft loss, estimated glomerular filtration rate, and death. In addition, we calculated the frailty score. Results: The study included 87 patients. Of these, 16.1% were classified as frail at the admission for KTx. There was no statistical significance in the association between pre-KTx frailty and the outcomes studied after 12 months. There was a 69.9% reduction (15.6% versus 4.7%; p = 0.023) in the proportion of frail individuals at the end of the 12-month follow-up period. Among the frailty components, weight loss showed a statistically significant improvement (34.4% versus 6.3%; p < 0.001). 84.4% of the patients remained non-frail, no patient progressed to frailty, 4.7% remained frail, and 10.9% were no longer frail at the end of the follow-up period. Conclusion: Frailty did not predict the outcomes of acute graft rejection, graft loss, estimated glomerular filtration rate, and death at the end of the study follow-up period. There was a 69.9% reduction in frail Milena dos Santos Mantovani Fragilidade como preditora de complicações no transplante renal. Estudo de coorte de 12 meses. patients 12 months after KTx. Weight loss was the component of frailty that showed a statistically significant improvement within this period.
Introduction: Today, kidney transplantation (KTx) is the best therapeutic alternative for end-stage chronic kidney disease patients. During the screening of patients for KTx, careful assessments are performed to minimize unfavorable outcomes. Although the classic eligibility criteria for KTx are well established in the literature, frailty, a measure of the physiological reserve, has been used for predicting relevant outcomes for this population. However, we did not identify studies that used this tool in a Brazilian series. Similarly, few studies have evaluated the transition of frailty state and its components after KTx. Objective: To assess frailty as a predictor of outcomes and evaluate the transitions in physical frailty phenotype 12 months after KTx. Methods: We conducted a prospective and longitudinal study that included patients aged 18 years who underwent KTx between March 2017 and March 2018. We excluded patients with combined transplants and those who had criteria that did not allow the application of the frailty score. All patients were evaluated at the time of admission for KTx. Demographic, clinical, anthropometric, laboratory, and KTx data were collected from medical records and interviews with the patients. The frailty score was simultaneously calculated. Twelve months after KTx, we evaluated the outcomes of acute graft rejection, graft loss, estimated glomerular filtration rate, and death. In addition, we calculated the frailty score. Results: The study included 87 patients. Of these, 16.1% were classified as frail at the admission for KTx. There was no statistical significance in the association between pre-KTx frailty and the outcomes studied after 12 months. There was a 69.9% reduction (15.6% versus 4.7%; p = 0.023) in the proportion of frail individuals at the end of the 12-month follow-up period. Among the frailty components, weight loss showed a statistically significant improvement (34.4% versus 6.3%; p < 0.001). 84.4% of the patients remained non-frail, no patient progressed to frailty, 4.7% remained frail, and 10.9% were no longer frail at the end of the follow-up period. Conclusion: Frailty did not predict the outcomes of acute graft rejection, graft loss, estimated glomerular filtration rate, and death at the end of the study follow-up period. There was a 69.9% reduction in frail Milena dos Santos Mantovani Fragilidade como preditora de complicações no transplante renal. Estudo de coorte de 12 meses. patients 12 months after KTx. Weight loss was the component of frailty that showed a statistically significant improvement within this period.
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Fragilidade, Transplante renal, Desfechos