Kidney transplant recipients (KTRs) take multiple medications including immunosuppressants every day. Although polypharmacy is associated with frailty, the situation remains unknown in KTRs. The aim of the present study is to investigate the association between hyperpolypharmacy and frailty in KTRs. This study was a single-center, cross-sectional investigation carried out on KTRs between August 2018 and February 2019 at Osaka City University Hospital. Frailty was evaluated using the Kihon Checklist (KCL). The number of medications was determined from the regular medicines the participants took by mouth every day. Hyperpolypharmacy was defined as 10 or more medications. Statistical analyses were performed using multivariable logistic regression analyses and multivariable linear regression analyses. Of 211 KTRs enrolled in this study, the mean (SD) number of medicines taken orally regularly was 9.4 (3.4), and hyperpolypharmacy participants accounted for 41%. Hyperpolypharmacy was associated with both the total KCL score (odds ratio, 1.13; P = .016) and being frail compared with being robust (odds ratio, 5.70; P = .007) after adjustments for age, sex, and body mass index. The number of medications was associated with both the total KCL score (β = 0.20; P < .001) and being frail compared with being robust (β = 2.51; P < .001) after adjustments for age, sex, body mass index, dialysis vintage, time after transplant, serum albumin, and estimated glomerular filtration rate. The optimal cutoff value for the number of medications to detect frailty was 12 (area under the curve, 0.81). In KTRs, hyperpolypharmacy was prevalent and was associated with frailty.

Post-transplant hyperglycemia and new-onset diabetes mellitus after transplantation (NODAT) are common and important metabolic complications. Decreased insulin secretion and increased insulin resistance are important to the pathophysiologic mechanism behind NODAT. However, the progression of glucose intolerance diagnosed late after kidney transplantation remains clearly unknown. Enrolled in this study were 94 kidney transplant recipients and 134 kidney transplant donors, as the healthy controls, who were treated at our institution. The 75 g-oral glucose tolerance test (OGTT) was performed in the recipients, and the healthy controls received an OGTT before donor nephrectomy. We assessed the prevalence of glucose intolerance including impaired fasting glucose and/or impaired glucose tolerance, as well as insulin secretion and insulin resistance using the homeostasis model assessment, and compared the results between the two groups. Multivariate analysis after adjustment for age, gender, body mass index, estimated glomerular filtration rate, and systolic blood pressure showed that the prevalence of glucose intolerance, insulin resistance, insulin secretion, and 2 h plasma glucose levels were significantly higher in the kidney transplant recipients compared to the healthy controls. Elevation of insulin secretion in kidney transplant recipients may be compensatory for increase of insulin resistance. Impaired compensatory pancreas β cell function may lead to glucose intolerance and NODAT in the future.