An overview of frailty in kidney transplantation: Measurement, management and future considerations

Meera N. Harhay, Maya K. Rao, Kenneth J. Woodside, Kirsten L. Johansen, Krista L. Lentine, Stefan G. Tullius, Ronald F. Parsons, Tarek Alhamad, Joseph Berger, Xing Xing S. Cheng, Jaqueline Lappin, Raymond Lynch, Sandesh Parajuli, Jane C. Tan, Dorry L. Segev, Bruce Kaplan, Jon Kobashigawa, Darshana M. Dadhania, Mara A. McAdams-DeMarco

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre-and postkidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT. After KT, the impacts of surgery and immunosuppression represent additional health stressors that disproportionately impact individuals with frailty. Frailty metrics could improve the ability to identify KT candidates and recipients at risk for adverse health outcomes and those who could potentially benefit from interventions to improve their frail status. The Physical Frailty Phenotype (PFP) is the most commonly used frailty metric in ESKD research, and KT recipients who are frail at KT (20% of recipients) are twice as likely to die as nonfrail recipients. In addition to the PFP, many other metrics are currently used to assess pre-and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for posttransplant adverse outcomes, it is not factored into the current transplant program risk-Adjustment equations. Future studies are needed to explore pre-and post-KT interventions to improve or prevent frailty.

Original languageEnglish
Pages (from-to)1099-1112
Number of pages14
JournalNephrology Dialysis Transplantation
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2020

Keywords

  • aging
  • frailty
  • kidney transplantation
  • physical function
  • survival

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