Depression is the most prevalent mental health illness in ESRD patients. Physical frailty, a measure of physiologic reserve, is associated with depressive symptoms. They are both associated with adverse KT outcomes and may have a synergistic effect when present together.

METHODS: Depressive symptoms and the Fried frailty phenotype were measured among 641 adult KT recipients upon KT admission to Johns Hopkins Hospital (12/08-05/16). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies-Depression Scale (CES-D) in which two exhaustion questions were omitted due to overlap with a frailty component, resulting in a 14.4 score cutoff out of 54. Using adjusted survival analysis and Poisson regression, we tested whether depressive symptoms and frailty were associated with mortality and death-censored graft loss, as well as length of stay (LOS).

RESULTS: Among KT recipients, 8.9% exhibited depressive symptoms and 17.8% were frail. Depressive symptoms were significantly associated with frailty using the CES-D (OR=5.36, 95%CI:3.03-9.46, p<0.001). Frail KT recipients exhibiting depressive symptoms were at a higher risk of death-censored graft loss and a longer LOS than their non-frail and depressed counterparts (Table 1).

CONCLUSION: Depressive symptoms are more likely to be present in adult ESRD patients who are frail. Together, depression and frailty contribute to a higher risk of graft loss, a longer LOS, and possibly mortality. KT recipients who are both depressed and frail should be closely monitored in order to improve KT outcomes.

Table 1: Depression, Frailty and Adverse KT Outcomes

Figure 1: Depression vs Frailty Score

CITATION INFORMATION: Konel J, Warsame F, Ying H, Haugen C, McAdams DeMarco M, Segev D. Depressive Symptoms, Physical Frailty, and Kidney Transplant Adverse Outcomes. Am J Transplant. 2017;17 (suppl 3).

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