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. 2022 Jan 28;11(3):672.
doi: 10.3390/jcm11030672.

Outcomes of Frail Patients While Waiting for Kidney Transplantation: Differences between Physical Frailty Phenotype and FRAIL Scale

María José Pérez-Sáez  1 , Dolores Redondo-Pachón  1 , Carlos E Arias-Cabrales  1 , Anna Faura  1 , Anna Bach  1 , Anna Buxeda  1 , Carla Burballa  1 , Ernestina Junyent  1 , Marta Crespo  1 , Ester Marco  2   3 , Leocadio Rodríguez-Mañas  4 , Julio Pascual  1
Affiliations

Outcomes of Frail Patients While Waiting for Kidney Transplantation: Differences between Physical Frailty Phenotype and FRAIL Scale

María José Pérez-Sáez et al. J Clin Med. .

Abstract

Frailty is associated with poorer outcomes among patients waiting for kidney transplantation (KT). Several different tools to measure frailty have been used; however, their predictive value is unknown. This is a prospective longitudinal study of 449 KT candidates evaluated for frailty by the Physical Frailty Phenotype (PFP) and the FRAIL scale. During the study period, 296 patients received a KT, while 153 remained listed. Patients who did not get receive a transplant were more frequently frail according to PFP (16.3 vs. 7.4%, p = 0.013). Robust patients had fewer hospital admissions during the 1st year after listing (20.8% if PFP = 0 vs. 43.4% if ≥1, and 27.1% if FRAIL = 0 vs. 48.9% if ≥1) and fewer cardiovascular events (than FRAIL ≥ 1) or major infectious events (than PFP ≥ 1). According to PFP, scoring 1 point had an impact on patient survival and chance of transplantation in the univariate analysis. The multivariable analysis corroborated the result, as candidates with PFP ≥ 3 had less likelihood of transplantation (HR 0.45 [0.26-0.77]). The FRAIL scale did not associate with any of these outcomes. In KT candidates, pre-frailty and frailty according to both the PFP and the FRAIL scale were associated with poorer results while listed. The PFP detected that frail patients were less likely to receive a KT, while the FRAIL scale did not.

Keywords: FRAIL; frailty; kidney transplant waiting list.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of patient survival while listed according to their PFP and FRAIL scale score (n = 153). Time to follow-up (median IQR) 26 (16–39) months. (A) Patient survival among robust (PFP = 0) and both pre-frail and frail patients together (PFP ≥ 1); p = 0.039; (B) Patient survival among robust (PFP = 0), pre-frail (PFP = 1–2), and frail patients (PFP ≥ 3); p = 0.11; (C) Patient survival among robust (FRAIL = 0) and both pre-frail and frail patients together (FRAIL ≥ 1); p = 0.086; (D) Patient survival among robust (FRAIL = 0), pre-frail (FRAIL = 1–2), and frail patients (FRAIL ≥ 3); p = 0.22.
Figure 1
Figure 1
Kaplan–Meier curves of patient survival while listed according to their PFP and FRAIL scale score (n = 153). Time to follow-up (median IQR) 26 (16–39) months. (A) Patient survival among robust (PFP = 0) and both pre-frail and frail patients together (PFP ≥ 1); p = 0.039; (B) Patient survival among robust (PFP = 0), pre-frail (PFP = 1–2), and frail patients (PFP ≥ 3); p = 0.11; (C) Patient survival among robust (FRAIL = 0) and both pre-frail and frail patients together (FRAIL ≥ 1); p = 0.086; (D) Patient survival among robust (FRAIL = 0), pre-frail (FRAIL = 1–2), and frail patients (FRAIL ≥ 3); p = 0.22.
Figure 2
Figure 2
Kaplan–Meier curves of patient chance of transplantation while listed according to their PFP and FRAIL scale score (n = 449). Time to follow-up 15 (4–27) months. (A) Chance of transplantation among robust (PFP = 0) and both pre-frail and frail patients together (PFP ≥ 1); p = 0.034; (B) Chance of transplantation among robust (PFP = 0), pre-frail (PFP = 1–2), and frail patients (PFP ≥ 3); p = 0.008; (C) Chance of transplantation among robust (FRAIL = 0) and both pre-frail and frail patients together (FRAIL ≥ 1); p= 0.28; (D) Chance of transplantation among robust (FRAIL = 0), pre-frail (FRAIL = 1–2), and frail patients (FRAIL ≥ 3); p = 0.56.
Figure 2
Figure 2
Kaplan–Meier curves of patient chance of transplantation while listed according to their PFP and FRAIL scale score (n = 449). Time to follow-up 15 (4–27) months. (A) Chance of transplantation among robust (PFP = 0) and both pre-frail and frail patients together (PFP ≥ 1); p = 0.034; (B) Chance of transplantation among robust (PFP = 0), pre-frail (PFP = 1–2), and frail patients (PFP ≥ 3); p = 0.008; (C) Chance of transplantation among robust (FRAIL = 0) and both pre-frail and frail patients together (FRAIL ≥ 1); p= 0.28; (D) Chance of transplantation among robust (FRAIL = 0), pre-frail (FRAIL = 1–2), and frail patients (FRAIL ≥ 3); p = 0.56.
Figure 2
Figure 2
Kaplan–Meier curves of patient chance of transplantation while listed according to their PFP and FRAIL scale score (n = 449). Time to follow-up 15 (4–27) months. (A) Chance of transplantation among robust (PFP = 0) and both pre-frail and frail patients together (PFP ≥ 1); p = 0.034; (B) Chance of transplantation among robust (PFP = 0), pre-frail (PFP = 1–2), and frail patients (PFP ≥ 3); p = 0.008; (C) Chance of transplantation among robust (FRAIL = 0) and both pre-frail and frail patients together (FRAIL ≥ 1); p= 0.28; (D) Chance of transplantation among robust (FRAIL = 0), pre-frail (FRAIL = 1–2), and frail patients (FRAIL ≥ 3); p = 0.56.
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