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. 2021 Jul 10;15(1):109-118.
doi: 10.1093/ckj/sfab133. eCollection 2022 Jan.

Frailty among chronic kidney disease patients on the kidney transplant waiting list: the sex-frailty paradox

María José Pérez-Sáez  1 , Carlos E Arias-Cabrales  1 , Vanesa Dávalos-Yerovi  2 , Dolores Redondo  1 , Anna Faura  1 , María Vera  1 , Anna Bach  1 , Guillermo Pedreira  1 , Ernestina Junyent  1 , Marta Crespo  1 , Ester Marco  2 , Leocadio Rodríguez-Mañas  3 , Julio Pascual  1 ; , for the FRAIL-MAR Study Group
Affiliations

Frailty among chronic kidney disease patients on the kidney transplant waiting list: the sex-frailty paradox

María José Pérez-Sáez et al. Clin Kidney J. .

Abstract

Background: Frailty is defined as decreased physiologic reserve and resistance to stressors that predisposes patients towards poor health results. Its prevalence in chronic kidney disease (CKD) patients who are kidney transplant (KT) candidates is high. Frailty is associated with a higher rate of complications and mortality after transplant. It is unknown whether frailty phenotype differs depending on sex in this population.

Methods: This was a prospective longitudinal study of 455 KT candidates evaluated for frailty by physical frailty phenotype at the time of inclusion on the KT waiting list. Pre-frailty was defined as the presence of two criteria and frailty as three or more criteria. Univariate and multivariate analyses searched for associations of frailty status, frailty components and gender differences.

Results: Thirty percent of the total cohort resulted to be pre-frail (20%) or frail (10.3%), but disparities were observed between sexes, with 22.5% of men and 47.2% of women falling into one of these categories. Among frailty criteria, women presented with a higher percentage of exhaustion (39.6% versus 17%) and slowness (22.2% versus 9.6%) compared with men. Comorbidity burden was higher among frail men, whereas social factors were poorer between frail women. Disability was common among those patients who were frail, both men and women.

Conclusions: Frailty is twice as frequent in advanced CKD women as men. Frailty criteria distribution and phenotype seem to differ among sexes, which might have implications in terms of specific and individualized interventions to improve their status before transplantation.

Keywords: frailty; gender; kidney transplantation; risk factor; sex.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Frailty phenotype prevalence and criteria distribution among 455 kidney transplant candidates. A: Number of patients who scored positive 0 to 5 criteria. B: Percentage of patients who presented each different criteria.
FIGURE 2:
FIGURE 2:
Frailty phenotype prevalence and criteria distribution differences between male and female kidney transplant candidates.
See this image and copyright information in PMC

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