Frailty and factors associated with the change in frailty in adults waiting for kidney transplant: a retrospective, descriptive, longitudinal study
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Background: Frailty in kidney transplant candidates has been shown to be 16.4% nationally. Those who are frail have higher morbidity and mortality while waiting for transplantation. Given the scarcity of organs, frailty testing should be completed in kidney transplant candidates to tailor optimization strategies and anticipate post-transplant risks. The purpose of this study was to identify the change in frailty and the factors associated with the change in frailty in adults waiting for kidney transplantation to determine how often testing should occur. Methods: A retrospective, descriptive, longitudinal design was used. Using the Liver Frailty Index, frailty scores were obtained as part of usual care during kidney transplant waitlist appointments. Kidney transplant candidates with two frailty scores one year apart were included in the study. Demographic, comorbidities, dialysis information, and frailty scores were extracted from the electronic medical record. Results: The study included 262 kidney transplant candidates with a mean age of 57 years. The majority of the sample were male (66.4%), White (62.6%), diabetes was the etiology of end stage renal disease (34%), and on in-center hemodialysis (40.5%). Over the one-year period, 57.3% improved their frailty score and 42.7% worsened. The median difference between the pairs of frailty measures were not statistically different (z = 1.185, p = .069). With the variables distributed into three models, the multiple regression indicated that demographics accounted for 4.4% of the change in frailty score, comorbidities 1.7%, and dialysis information 1.8%. None of the models accounted for a statistically significant amount of variance in the change in frailty score. Conclusion: In congruence with prior results, frailty is dynamic and should be measured on all kidney transplant candidates at all waitlist appointments. In practice, knowledge of the frailty status of the kidney transplant candidate allows for the optimization of prehabilitation strategies and the identification of post-transplant risk. This could be accomplished with a change in national policy to require frailty testing, supported by a transplant frailty theory. Implications for future research include a multicenter replication of the study to increase generalizability and the use of the Liver Frailty Index in all solid organ transplant candidates.
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Introduction -- Review of literature -- Theoretical framework and methodology -- Results -- Discussion
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Ph.D. (Doctor of Philosophy)