Frailty and Access to Kidney Transplantation

Christine E. Haugen, Nadia Chu, Hao Ying, Fatima Warsame, Courtenay M. Holscher, Niraj M Desai, Miranda Jones, Silas P. Norman, Daniel Brennan, Jacqueline Garonzik, Jeremy D Walston, Adam W. Bingaman, Dorry Segev, Mara Ann McAdams Demarco

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Frailty, a syndrome distinct from comorbidity and disability, is clinically manifested as a decreased resistance to stressors and is present in up to 35% of patient with ESKD. It is associated with falls, hospitalizations, poor cognitive function, and mortality. Also, frailty is associated with poor outcomes after kidney transplant, including delirium and mortality. Frailty is likely also associated with decreased access to kidney transplantation, given its association with poor outcomes on dialysis and post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought to quantify if frail kidney transplant candidates had similar access to kidney transplantation as nonfrail candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 7078 kidney transplant candidates (2009-2018) in a three-center prospective cohort study of frailty. Fried frailty (unintentional weight loss, grip strength, walking speed, exhaustion, and activity level) was measured at outpatient kidney transplant evaluation. We estimated time to listing and transplant rate by frailty status using Cox proportional hazards and Poisson regression, adjusting for demographic and health factors. RESULTS: The mean age was 54 years (SD 13; range, 18-89), 40% were women, 34% were black, and 21% were frail. Frail participants were almost half as likely to be listed for kidney transplantation (hazard ratio, 0.62; 95% confidence interval, 0.56 to 0.69; P<0.001) compared with nonfrail participants, independent of age and other demographic factors. Furthermore, frail candidates were transplanted 32% less frequently than nonfrail candidates (incidence rate ratio, 0.68; 95% confidence interval, 0.58 to 0.81; P<0.001). CONCLUSIONS: Frailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.

Original languageEnglish (US)
Pages (from-to)576-582
Number of pages7
JournalClinical journal of the American Society of Nephrology : CJASN
Volume14
Issue number4
DOIs
StatePublished - Apr 5 2019

Fingerprint

Kidney Transplantation
Transplants
Kidney
Demography
Confidence Intervals
Mortality
Delirium
Hand Strength
Cognition
Comorbidity
Weight Loss
Dialysis
Hospitalization
Cohort Studies
Outpatients
Prospective Studies
Incidence
Health

Keywords

  • Accidental Falls
  • Cognition
  • Comorbidity
  • Counseling
  • Frailty
  • Hand Strength
  • hospitalization
  • Incidence
  • Kidney Failure, Chronic
  • kidney transplantation
  • outcomes
  • Outpatients
  • Prospective Studies
  • renal dialysis
  • risk factors
  • Transplants
  • Walking Speed
  • Weight Loss

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Frailty and Access to Kidney Transplantation. / Haugen, Christine E.; Chu, Nadia; Ying, Hao; Warsame, Fatima; Holscher, Courtenay M.; Desai, Niraj M; Jones, Miranda; Norman, Silas P.; Brennan, Daniel; Garonzik, Jacqueline; Walston, Jeremy D; Bingaman, Adam W.; Segev, Dorry; McAdams Demarco, Mara Ann.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 14, No. 4, 05.04.2019, p. 576-582.

Research output: Contribution to journalArticle

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AU - Desai, Niraj M

AU - Jones, Miranda

AU - Norman, Silas P.

AU - Brennan, Daniel

AU - Garonzik, Jacqueline

AU - Walston, Jeremy D

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N2 - BACKGROUND AND OBJECTIVES: Frailty, a syndrome distinct from comorbidity and disability, is clinically manifested as a decreased resistance to stressors and is present in up to 35% of patient with ESKD. It is associated with falls, hospitalizations, poor cognitive function, and mortality. Also, frailty is associated with poor outcomes after kidney transplant, including delirium and mortality. Frailty is likely also associated with decreased access to kidney transplantation, given its association with poor outcomes on dialysis and post-transplant. Yet, clinicians have difficulty identifying which patients are frail; therefore, we sought to quantify if frail kidney transplant candidates had similar access to kidney transplantation as nonfrail candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 7078 kidney transplant candidates (2009-2018) in a three-center prospective cohort study of frailty. Fried frailty (unintentional weight loss, grip strength, walking speed, exhaustion, and activity level) was measured at outpatient kidney transplant evaluation. We estimated time to listing and transplant rate by frailty status using Cox proportional hazards and Poisson regression, adjusting for demographic and health factors. RESULTS: The mean age was 54 years (SD 13; range, 18-89), 40% were women, 34% were black, and 21% were frail. Frail participants were almost half as likely to be listed for kidney transplantation (hazard ratio, 0.62; 95% confidence interval, 0.56 to 0.69; P<0.001) compared with nonfrail participants, independent of age and other demographic factors. Furthermore, frail candidates were transplanted 32% less frequently than nonfrail candidates (incidence rate ratio, 0.68; 95% confidence interval, 0.58 to 0.81; P<0.001). CONCLUSIONS: Frailty is associated with lower chance of listing and lower rate of transplant, and is a potentially modifiable risk factor.

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KW - kidney transplantation

KW - outcomes

KW - Outpatients

KW - Prospective Studies

KW - renal dialysis

KW - risk factors

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KW - Walking Speed

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