Frailty in kidney transplant candidates and recipients: pathogenesis and intervention strategies

Effect of a home-based physical rehabilitation program via virtual reality on the functional outcomes of frail older adults: a quasi-experimental study

Given the rapid aging of the population in Egypt, efforts to slow down or prevent frailty. Virtual reality technology constitutes a promising rehabilitation strategy, but its effect on frailty in older adults remains inconclusive. A non-equivalent control pre, post, and follow-up test design was used with a sample of 70 prefrail or frail older adults. In 3 urbans affiliated to Dakahlia governorate, tools of data collection; Mini-Cog, Structured Interview Schedule, Survey of Health, Aging and Retirement in Europe of the Frailty Indicator (FI), Short Physical Performance Battery, and Falls Efficacy Scale. For each group, a significant improvement in frailty, physical performance, and falls from each measurement period to immediately after (p < 0.001), and within the 30-days study period while those in the control group were relatively stable over time and sometime worsen. The baseline characteristics and assessment results were similar between groups. We observed significant improvements in the intervention group in terms of frailty criteria, standing balance, gait speed, chair stand, and fear of fall. No improvements were observed in the control group, we anticipate a decrease in frailty index, and increase in standing balance, reinforcing the proven benefits of the exercise in this vulnerable population.

Frailty in the context of kidney transplantation

Frailty, defined as an inappropriate response to stressful situations due to the loss of physiological reserve, was initially described in the elderly population, but is currently being identified in younger populations with chronic diseases, such as chronic kidney disease. It is estimated that about 20% of patients are frail at the time of kidney transplantation (KT), and there is great interest in its potential predictive value for unfavorable outcomes. A significant body of evidence has been generated; however, several areas still remain to be further explored. The pathogenesis is poorly understood and limited to the extrapolation of findings from other populations. Most studies are observational, involving patients on the waiting list or post-KT, and there is a scarcity of data on long-term evolution and possible interventions. We reviewed studies, including those with Brazilian populations, assessing frailty in the pre- and post-KT phases, exploring pathophysiology, associated factors, diagnostic challenges, and associated outcomes, in an attempt to provide a basis for future interventions.

Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management

Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease-mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation.