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Pretransplant Physical Functioning and Kidney Patients’ Risk for Posttransplantation Hospitalization/Death: Evidence from a National Cohort

Nancy G. Kutner^*, Rebecca Zhang^*, Tess Bowles^*, and Patricia Painter

^* Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, Emory University, Atlanta, Georgia; and Department of Physiological Nursing, University of California at San Francisco, San Francisco, California

Address correspondence to: Dr. Nancy G. Kutner, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322. Phone: 404-712-5561; Fax: 404-712-5895; E-mail: nkutner{at}emory.edu

Patient physical functioning level is an indicator of medical fitness that may predict outcomes after kidney transplantation. A small study of patients at a single center found a correlation between patient-rated physical functioning pretransplantation and the number of emergency hospital visits posttransplantation. In a national multicenter cohort, the association of incident dialysis patients’ physical functioning scores with their risk for posttransplantation all-cause hospitalization/death was investigated using Cox proportional hazards analysis. The study cohort included patients who participated in the Dialysis Morbidity and Mortality Study (DMMS) Wave 2 and received a first transplant no more than 24 mo after treatment start. Updated patient information was available in the 2004 United States Renal Data System Standard Analysis Files. Higher pretransplantation physical functioning score was found to be a significant predictor of transplant recipients’ reduced risk for hospitalization/death. Patients in the Cox model who were aged 55+ had increased risk for hospitalization/death. Gender, race, diabetic ESRD, and cardiovascular comorbidity were NS predictors. A potential explanation for the ability of the Medical Outcomes Study Short-Form 36 physical functioning measure to predict risk for posttransplantation morbidity/mortality is that physical activity/exercise behavior is likely to be closely associated with an individual’s physical functioning level, and pretransplantation activity levels may be indicative of lifestyle habits that continue to influence patient behavior posttransplantation. More research investigating patients’ pre- and posttransplantation physical functioning levels in relation to transplant outcomes would be valuable.