November 26, 2019
2 min read

Frailty common among US kidney transplant candidates, recipients

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Researchers of a published study estimated a high prevalence of frailty in both kidney transplant candidates and recipients across the United States, leading them to recommend assessing patients for frailty at transplant evaluation.

“Frailty is not commonly assessed at the time of evaluation, transplant, or collected in national registries, despite its association with poor outcomes in [kidney transplant] KT candidates and recipients,” Christine E. Haugen, MD, of the department of surgery at Johns Hopkins University School of Medicine, and colleagues wrote. “In 2018 in the United States, 94,970 adults were listed for KT and 21,167 underwent KT, and likely a large percentage of those KT recipients were frail. Additionally, frailty is more common in older KT candidates and KT recipients, and the number of older adults undergoing KT is increasing overtime ... Thus, national estimates of frailty across all states, donor services areas, and transplant centers may help guide interventions to reduce or lessen the burden of frailty in the growing population of vulnerable KT candidates and recipients.”

Using data from a prospective, longitudinal multicenter cohort study, researchers estimated the prevalence of frailty in 4,616 kidney transplant candidates and 1,763 recipients. Frailty was determined with the Fried physical frailty phenotype, which considers unintentional weight loss, weakness based on grip-strength, exhaustion, low activity and slowed walking speed. They found that, at evaluation, 13.3% of transplant candidates were frail. At transplantation, 8.2% of living donor recipients and 17.8% of deceased donor recipients were frail.

Researchers estimated the national prevalence of frailty by mapping data from this cohort onto the national transplant population (through use of the Scientific Registry of Transplant Recipients, which included 560,143 candidates and 243,508 recipients).

Estimates showed that, respectively, 16.4% and 14.3% of all candidates and recipients were frail during the course of a 10-year study period (living donor recipients, 8.2%; deceased donor, 17.8%).

Further observation indicated the prevalence of frailty varied across the United States, with the highest concentration of pre-frail and frail candidates in California and New York. Lowest access to transplant in frail candidates occurred in California, Texas, Alabama and Georgia.

Researchers also hypothesized that the reason their finding of frailty prevalence in kidney transplant candidates was lower than in studies of patients on hemodialysis may be due to the fact frail participants have a decreased chance of being listed for kidney transplant at evaluation.

“Given the high prevalence of frailty, transplant programs should consider assessing frailty during KT evaluation to improve informed consent and identify candidates for pre-KT interventions,” they concluded. “Our findings can encourage centers to include frailty as part of their evaluation and help identify a vulnerable population of patients that may benefit from potential interventions like prehabilitation.” – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.