Background: Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor\nphysical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels\namong end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes\nsuch as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may\ndiffer between AA and non-AA ESRD patients.\nMethods: One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014-5/2017),\nand inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP])\nwere measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical\nPerformance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and\ntested whether these associations differed by race (AA vs. non-AA).\nResults: Non-AAs had lower levels of TNFR1 (9.7 ng/ml vs 14.0 ng/ml, p < 0.001) and inflammatory index (6.7 vs 6.8,\np < 0.001) compared to AAs, but similar levels of IL-6 (4.5 pg/ml vs 4.3 pg/ml, p > 0.9) and CRP (4.7 microg/ml vs 4.9 microg/ml,\np = 0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RR = 1.58, 95% CI:1.27-1.96, p < 0.001), TNFR1\n(RR = 1.60, 95% CI:1.25-2.05, p < 0.001), CRP (RR = 1.41, 95% CI:1.10-1.82, p < 0.01), and inflammatory index (RR = 1.82,\n95% CI:1.44-2.31, p < 0.001). The associations between elevated inflammatory markers and frailty were not present\namong AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL.\nConclusions: Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from\nprehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant.
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