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Kidney Week

Abstract: TH-PO668

Poor Outcomes in Kidney Transplant (KT) Candidates and Recipients with History of Falls

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Chu, Nadia M., Johns Hopkins, Baltimore, Maryland, United States
  • Shi, Zhan, Johns Hopkins, Baltimore, Maryland, United States
  • Haugen, Christine E., Johns Hopkins, Baltimore, Maryland, United States
  • Norman, Silas, University of Michigan Health Systems, Ann Arbor, Michigan, United States
  • Segev, Dorry L., Johns Hopkins, Baltimore, Maryland, United States
  • McAdams-DeMarco, Mara, Johns Hopkins, Baltimore, Maryland, United States
Background

In patients with ESKD, serious falls resulting in hospitalization/fractures lead to lower chance of listing or KT. While it is likely that candidates and recipients have high frequency of injurious and noninjurious falls, it is unclear if less serious, noninjurious falls also lead to lower access to KT and if these risks extend to poor outcomes post-KT.

Methods

Using a 2-center cohort of KT candidates (n=3,666) and recipients (n=769), we assessed time to listing (Cox), waitlist mortality (Cox), and KT rate (Poisson) for KT candidates by history of falls (self-report, past 6 months) and recurrent falls (≥2 falls); for recipients, we assessed risk of mortality (Cox), all-cause graft loss (ACGL) (Cox), and length of stay (LOS) (Poisson).

Results

In candidates, 16.3% had history of falls; 6.5% had recurrent falls. Candidates with recurrent falls had lower chance of listing (aHR=0.7, 95%CI:0.6-0.8); those with single fall had a lower KT rate (aIRR=0.7, 95%CI:0.5-0.9). Single and recurrent falls were associated with greater mortality risk at evaluation and 1-year after evaluation; this risk declined over time. In KT recipients, 12.5% had a history of falls; 5.1% had recurrent falls. Single falls were associated with greater mortality risk (aHR=9.2, 95%CI:3.4-25.1) and ACGL (aHR=7.3, 95%CI:2.9-18.6) at KT and at 1-year post-KT; these risks declined thereafter. KT recipients with recurrent falls were at increased risk of a longer LOS (aHR=1.1, 95%CI:1.0-1.3).

Conclusion

Candidates (6.5%) and recipients (5.1%) had recurrent falls which were associated with decreased chance of listing and increased risk of waitlist mortality, post-KT mortality/ACGL, and longer LOS. Centers should consider employing falls prevention strategies as part of a comprehensive prehabilitation intervention.

Funding

  • NIDDK Support