Uremic Symptoms: A Patient-Reported Outcome That is Associated with Access to Kidney Transplantation and Waitlist Mortality among Kidney Transplant Candidates
1Johns Hopkins University School of Nursing, Baltimore, MD, 2Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 3Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 4Division of Nephrology, University of Michigan, Ann Arbor, MI, 5Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, 6Division of Nephrology, University of Mississippi Medical Center, Jackson, MS
Meeting: 2020 American Transplant Congress
Abstract number: 268
Keywords: Kidney transplantation, Quality of life, Survival
Session Information
Date: Saturday, May 30, 2020
Session Name: All Organs: Disparities to Outcome and Access to Healthcare I
Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
Location: Virtual
*Purpose: Patient-reported symptoms of uremia – pruritis, anorexia and fatigue – reflect incomplete removal of uremic toxins by dialysis and are likely one of the causes of frailty in patients with end-stage kidney disease seeking kidney transplantation (KT). Given that frailty is associated with decreased access to KT, the main goals of this study were to assess: 1) the prevalence of uremic symptoms among patients being evaluated for KT; 2) the chance of listing for KT and rate of KT by uremic symptoms at time of evaluation; and 3) the risk of KT waitlist mortality by uremic symptoms.
*Methods: We leveraged a two-center prospective cohort study of 2,364 participants (5/2014-12/2018) enrolled at KT evaluation. We calculated uremic symptom scores using 3 KDQOL-36 items (pruritis, anorexia, and fatigue). Possible scores ranged from 0 – 12. We categorized participants into 3 groups by uremic symptom scores (no symptoms: 0 – 4; moderate symptoms: 5 – 8; severe symptoms: 9 – 12). We estimated adjusted chance of listing (Cox regression), risk of waitlist mortality (competing risks regression), and KT rate (Poisson regression) by uremic symptom scores.
*Results: At KT evaluation, 20% of patients experienced moderate uremic symptoms and 4% experienced severe uremic symptoms. Patients with moderate symptoms (PR = 1.85; 95% CI: 1.50 – 2.27) and severe symptoms (PR = 2.55; 95% CI: 1.82 – 3.56) were more likely to be frail. For every 1 point increase in uremic symptom score, there was a 4% lower chance of listing (HR = 0.96; 95% CI: 0.94 – 0.99). Patients with severe uremic symptoms had a lower transplant rate (IRR = 0.38; 95% CI: 0.16 – 0.91) and higher risk of waitlist mortality (HR = 3.36; 95% CI: 1.52 – 7.42).
*Conclusions: This study adds insight into established associations between frailty and adverse outcomes in patients living with kidney disease by linking vulnerability to stressors, symptoms, and pre-KT outcomes. Transplant providers should recognize the importance of severe uremic symptoms among patients being evaluated for KT and that this group is likely to be frail leading to poor access to KT and high waitlist mortality. Future studies should identify whether psychosocial factors, like dialysis nonadherence, or physiologic factors, like buildup of uremic toxins, contribute to the association between uremic symptoms and waitlist outcomes.
To cite this abstract in AMA style:
Taylor K, Chu N, Shi Z, Rosello E, Kunwar S, Butz P, Norman S, Crews D, Greenberg K, Segev D, Shafi T, McAdams-DeMarco M. Uremic Symptoms: A Patient-Reported Outcome That is Associated with Access to Kidney Transplantation and Waitlist Mortality among Kidney Transplant Candidates [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/uremic-symptoms-a-patient-reported-outcome-that-is-associated-with-access-to-kidney-transplantation-and-waitlist-mortality-among-kidney-transplant-candidates/. Accessed March 9, 2021.« Back to 2020 American Transplant Congress