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

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.

Figure 1.. Perceptions of the essential components of frailty by kidney transplant programs (n = 133).

Participants were asked, “In your view, what components are essential in assessing frailty?” and were asked to select either important or less important for each component.

Figure 2.. Frequency of frailty assessments conducted by transplant programs at evaluation for kidney transplantation (KT) and at admission for KT (n = 133).

Participants were asked, “Do you currently perform a standardized frailty assessment as part of evaluation for kidney transplant candidacy [for kidney transplant recipients at the time of transplantation] in your practice?”

Figure 3.. The most commonly used tools to assess frailty among kidney transplant programs (n = 133).

Participants were asked, “What tool for the assessment of frailty do you currently use routinely?” and were able to select all that applied.