Perceptions and Practices Regarding Frailty in Kidney Transplantation: Results of a National Survey

• Type of Material: Article
• Authors: Mara A. McAdams-DeMarco, Johns Hopkins University; Sarah E. Van Pilsum Rasmussen, Johns Hopkins University; Nadia M. Chu, Johns Hopkins University; Dayawa Agoons, Johns Hopkins University; Ronald Parsons, Emory University; Tarek Alhamad, Washington University; Kirsten L. Johansen, Hennepin County Medical Center; Stefan G. Tullius, Harvard University; Raymond Lynch, Emory University; Meera N. Harhay, Drexel University; Maya K. Rao, Columbia University; Joseph Berger, University of Texas Southwestern Medical School; Matthew Cooper, Georgetown University; Jane C. Tan, Stanford University; XingXing S. Cheng, Stanford University; Kenneth J. Woodside, University of Michigan; Sandesh Parajuli, University of Wisconsin; Krista L. Lentine, St Louis University; Bruce Kaplan, Baylor Scott & White Health; Dorry L. Segev, Johns Hopkins University; Jon A. Kobashigawa, Cedars Sinai Medical Center; Darshana Dadhania, Weill Cornell Medical College
• Language: English
• Date: 2020-02-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/TP.0000000000002779
• Title of Journal or Parent Work: Transplantation
• Volume: 104
• Issue: 2
• Start Page: 349
• End Page: 356
• Grant/Funding Information: Maya K. Rao was supported by NIH grant (R03AG053294).; Mara McAdams-DeMarco was also supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334) and NIH grant (K01AG043501).; Jane Tan was supported by the John M. Sobrato Foundation.; This study was supported by NIH grant R01AG042504 (PI: Dorry Segev), R01AG055781 (PI: McAdams-DeMarco) and K24DK101828 (PI: Dorry Segev).; Raymond Lynch was supported by NIH grant (MDO11682).; Stefan G. Tullius was supported by NIH grant (R01/R56: AG039449).; Meera Harhay was supported by NIH grant (K23DK105207).
• Keywords: Transplantation; Incident; Hemodialysis; Immunology; Exercise; Impairment; Older adults; Age; Cognitive function; Mortality; Life Sciences & Biomedicine; Science & Technology; Surgery
• Research Categories: Health Sciences, Immunology; Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background. Given the potential utility of frailty, a clinical phenotype of decreased physiologic reserve and resistance to stressors, to predict postkidney transplant (KT) outcomes, we sought to understand the perceptions and practices regarding frailty measurement in US KT programs. Methods. Surveys were emailed to American Society of Transplantation Kidney/Pancreas Community of Practice members and 202 US transplant programs (November 2017 to April 2018). Program characteristics were gleaned from Scientific Registry of Transplant Recipients. Results. The 133 responding programs (response rate = 66%) represented 77% of adult KTs and 79% of adult KT candidates in the United States. Respondents considered frailty to be a useful concept in evaluating candidacy (99%) and endorsed a need to develop a frailty measurement specific to KT (92%). Frailty measurement was more common during candidacy evaluation (69%) than during KT admission (28%). Of the 202 programs, 38% performed frailty assessments in all candidates while 23% performed assessments only for older candidates. There was heterogeneity in the frailty assessment method; 18 different tools were utilized to measure frailty. The most common tool was a timed walk test (19%); 67% reported performing >1 tool. Among programs that measure frailty, 53% reported being less likely to list frail patients for KT. Conclusions. Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered.