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Kidney Week

Abstract: PO1383

Differences in Frailty by Sex in Kidney Transplant Candidates

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Worthen, George Laurence, Dalhousie University, Halifax, Nova Scotia, Canada
  • Vinson, Amanda Jean, Dalhousie University, Halifax, Nova Scotia, Canada
  • Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada

Group or Team Name

  • Frailty Assessments in Canadians being Evaluated for Transplant Study (FACETS)
Background

Frailty prevalence is higher in women, despite the observed protective effect of female sex on mortality in the general population. Understanding whether there are differences in perceived frailty by sex and the differential impact of frailty on outcomes for males versus females is crucial to avoid a sex disparity within the transplant assessment process.

Methods

We analyzed initial frailty assessments for patients enrolled in a multicenter prospective cohort study across 6 kidney transplant referral centers. Frailty was assessed using the Frailty Phenotype (FP; 3 of slowness, weight loss, low activity, exhaustion, and weakness), a Frailty Index (FI; including 37 variables across the domains of social function/cognition, function, mobility, and comorbidity), and the Clinical Frailty Scale (CFS, based on clinical judgement). Assessments were performed prior to or shortly after waitlisting. Prevalence of frailty as measured by the FP, FI, and CFS was reported. An unadjusted cox survival analysis (separately for males and females) was used to assess the effect of frailty on time to death or withdrawal from the waitlist among activated patients.

Results

A total of 767 unique patients had frailty assessments performed between 2016-2021. Patients were predominantly of male sex (64%), white race (82%) and had a mean age of 54+/-14. The prevalence of frailty for women was not significantly higher by the FP (16% vs 13%, p=0.15) or the FI (48% vs 46%, p=0.38), but was by the CFS (17% vs 12%, p=0.05). Among 325 activated patients, frailty by the CFS was significantly associated with death/withdrawal for men (HR 2.59; 95% CI 1.16-6.79) but not women (HR 1.41; 95% CI 0.48-4.18).

Conclusion

The prevalence of frailty was higher in females when measured by the CFS, but not by a transplant specific FI or the FP. Despite this, frailty was not significantly associated with mortality/withdrawal from the waitlist for female individuals, emphasizing the need to critically evaluate judgement based frailty assessments and their role in the transplant evaluation process.

Funding

  • Government Support – Non-U.S.