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Kidney Week

Abstract: PO2064

Association of Physical Performance with Death or Delisting in Patients Waitlisted for Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Sheshadri, Anoop, San Francisco VA Health Care System, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
  • Adey, Deborah B., University of California San Francisco, San Francisco, California, United States
  • Lai, Jennifer C., University of California San Francisco, San Francisco, California, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
Background

Patients awaiting kidney transplantation (KT) often report impairments in functional status, which are associated with higher risk of death or delisting. However, self-reported functional status is subjective and can differ from objective assessments of physical performance. We sought to determine whether objective metrics of physical performance were associated with death or delisting prior to KT and whether these metrics improve prediction of death or delisting compared with more routinely available clinical data.

Methods

We enrolled 443 patients from the UCSF KT clinic from 12/17–3/20 at an initial or re-evaluation for eligibility for a first KT. We administered the Short Physical Performance Battery (SPPB; including gait speed, balance, and sit-to-stand) and measured grip strength by dynamometer. We performed univariable and multivariable Cox models to examine the association between physical performance and death or delisting. We created models using combinations of metrics in addition to a “base” model for death or delisting (age, sex, diabetes, CAD, CVD, PVD, years on dialysis) and calculated Harrell’s concordance index for each model.

Results

Median age was 55 years, and 63% were male. Median SPPB score was 10 (8, 11), with 25.1% having gait speed <0.8 m/s. In multivariable analysis, lower SPPB and slower gait were associated with higher risk of death or delisting, and higher grip strength with lower risk (Table 1). Compared with the base model (C-index 0.70, strongest predictor: age), addition of SPPB (0.74; p=0.03) and SPPB + grip strength (0.75, p=0.03) improved discrimination.

Conclusion

SPPB, grip strength, and slower gait were associated with death or delisting. SPPB and grip strength improved prediction of death or delisting. Transplant centers should consider routinely evaluating physical performance for waitlisted patients to help with clinical decision making.

Association of physical performance with death or delisting among 443 patients evaluated for primary KT
 Unadjusted HR (95% CI)p-valueMultivariable HR (95% CI)p-value***
SPPB (per category)*2.26 (1.70, 3.02)<0.01**1.99 (1.41, 2.81)<0.01
Gait speed <0.8 m/s2.55 (1.46, 4.47)<0.011.89 (1.01, 3.52)0.05
Grip Strength (per kg)0.95 (0.92, 0.98)<0.010.94 (0.90, 0.97)<0.01

*SPPB: 10-12 [ref], 7-9, 4-6, <4 **Linear test for trend among categories of SPPB p <0.01 ***Adjusted for covariates in "base" model

Funding

  • NIDDK Support