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Abstract: PO1704

A Comparison of Frailty Measures Among Patients Referred for Kidney Transplantation

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Worthen, George Laurence, Dalhousie University, Halifax, Nova Scotia, Canada
  • Suri, Rita, McGill University, Montreal, Quebec, Canada
  • Gunaratnam, Lakshman, Western University, London, Ontario, Canada
  • Yohanna, Seychelle, McMaster University, Hamilton, Ontario, Canada
  • Walsh, Michael, McMaster University, Hamilton, Ontario, Canada
  • Prasad, Bhanu, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
  • Doucette, Steve, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
  • Rockwood, Kenneth John, Dalhousie University, Halifax, Nova Scotia, Canada
  • Vinson, Amanda Jean, Dalhousie University, Halifax, Nova Scotia, Canada
  • West, Kenneth A., Dalhousie University, Halifax, Nova Scotia, Canada
  • Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada
Background

Frailty is highly prevalent in patients referred for kidney transplantation. While the Fried Frailty Phenotype (FP) is widely used, less is known about other frailty assessment tools. We assessed and compared the prevalence of frailty using three tools in kidney transplant waitlist candidates.

Methods

Kidney transplant waitlist candidates were prospectively enrolled from five centers from June 2016-Feb 2020. Frailty was primarily defined using the FP as three or more of slowness (using walk time), weakness (using grip strength), weight loss, low activity or exhaustion (the latter three using questionnaires). Secondary tools included a Frailty Index (FI) consisting of 37 variables across the domains of social function/cognition, function, mobility and comorbidity, and the Clinical Frailty Scale (CFS), a frailty screen based on clinician gestalt that ranges from 1 (very fit) to 8 (very severely frail). We used adjusted logistic regression to identify factors associated with frailty measured by the FP. Area under the receiver-operator characteristics (ROC) curves were calculated to compare the FP to the FI and CFS.

Results

Of 542 enrolled patients, 64% were male, 80% were white, and the mean age was 54±14. The prevalence of frailty by the FP was 16%; it was 27% for those >65 years old. Of the FP components, low grip strength (41%), and exhaustion (36%) were the most prevalent. Using an established cut point of 0.25 yielded a prevalence of 38% by the FI (46% for those >65). Using a cut-off of 5 on the CFS (mildly frail), frailty prevalence was 4% (7% for those >65). The mean FI score was 0.23±0.14 (max 0.70) and median CFS score was 3 (IQR 2,3) or “managing well”. Diabetes (adjusted odds ratio; aOR 2.0, 95% CI 1.0, 3.8), and cerebrovascular disease (aOR 3.3 95% CI 1.3, 8.5) were associated with frailty defined by the FP. Area under the ROC curve for the FP and FI/CFS were 0.86 (good) and 0.69 (poor) respectively.

Conclusion

The prevalence of frailty varies using different measurement tools and there are differences in perceived (CFS) versus measured (FP/FI) frailty among patients referred for transplantation. Determining which tool is most associated with outcomes for waitlisted patients is a future objective of this study.