Frailty assessment can be successfully implemented into kidney transplant evaluation
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Researchers successfully integrated a physical frailty assessment into routine screening for kidney transplant candidates, which may allow for a better understanding of potential risks and complications.
In a poster presented at the virtual American Transplant Congress, Joanna M. Schaenman, MD, PhD, of the David Geffen School of Medicine at UCLA, and colleagues, wrote, “Our objective was to implement a standardized assessment of physical frailty and other aging-associated syndromes during routine evaluation of kidney transplant candidates over age 55 [years], to provide additional information during candidacy evaluation for older patients at risk for post-transplant complications.”
The tool they developed, which was implemented in April 2018 and tested in 90 patients, included multiple standardized measures to assess geriatric syndromes. These included the Fried frailty phenotype (FFP), the short physical performance battery (SPPB), activities of daily living (ADLs), cognitive function (mini-Cog) and fall-risk.
According to the researchers, the assessment can be completed in two steps (self-reported survey responses from patients in the waiting room and performance testing administered by a health care professional), which makes it time efficient at an estimated 10 minutes per patient.
The SPPB indicated 32% of patients were pre-frail, 31% were frail and 37% were non-frail, while the FFP suggested 24% were frail and 76% were pre-frail.
Of the 90 patients included, 41 patients underwent transplantation and three died.
Median length of stay after transplant was 5.5 days, and 33 patients were readmitted.
Researchers found that while frailty assessed with the SPPB was significantly associated with both length of stay and mortality, frailty as assessed by FFP was not (though, the researchers noted observing a trend toward association with increased length of stay).
A trend was also observed toward characterization as frail or pre-frail and hospital readmission within the first 3 months of transplantation when assessed by the SPPB.
Due to the discrepancies between the SPPB and FFP, the researchers recommended future studies be conducted to evaluate which assessment is the most accurate. In addition, they suggested looking at the association between frailty and cognitive function, activities of daily living and fall risk.
Of this study, the researchers concluded: “Through a streamlined, team-based effort, we were able successfully integrate evaluation of frailty and other aging-associated risk factors into patient assessment during outpatient clinic assessment.”
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Schaenman JM, et al. Poster #30-01B. Presented at: American Transplant Congress; May 30 - June 1, 2020. (virtual meeting).
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