Engaging clinicians and patients to assess and improve frailty measurement in adults with end stage renal disease

Rasmussen, Sarah E. Van Pilsum; Konel, Jonathan; Warsame, Fatima; Hua, Ying; Buta, Brian; Haugen, Christine E.; King, Elizabeth A.; DiBrito, Sandra R.; Varadhan, Ravi; Rodríguez‐Mañas, Leocadio; Walston, Jeremy D.; Segev, Dorry L.; McAdams‐DeMarco, Mara

doi:10.1186/s12882-017-0806-0

Cited by 32 publications

(18 citation statements)

References 28 publications

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“…The most common form of prehabilitation includes exercise components with strength, aerobics, and stretching (62), although nutritional components (63)(64)(65) and psychological components (66) have been included. In a recent survey, both clinicians (97%) and patients (94%) agreed that pre-KT prehabilitation would help patients undergoing KT and that prehabilitation would make ESRD patients less frail (clinicians: 100% and patients: 84%) (67). Additionally, 97% of clinicians and 80% of patients agreed that patients would be interested in pre-KT prehabilitation (67).…”

Section: Unanswered Questionsmentioning

confidence: 99%

“…In a recent survey, both clinicians (97%) and patients (94%) agreed that pre-KT prehabilitation would help patients undergoing KT and that prehabilitation would make ESRD patients less frail (clinicians: 100% and patients: 84%) (67). Additionally, 97% of clinicians and 80% of patients agreed that patients would be interested in pre-KT prehabilitation (67). However, a multi-center randomized controlled trial of prehabilitation among frail KT recipients is needed to confirm the efficacy of this intervention in preventing long-term outcomes and associated costs.…”

Section: Unanswered Questionsmentioning

confidence: 99%

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Frailty and Long-Term Post-Kidney Transplant Outcomes

2019

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Purpose of review: To highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes. Recent findings: Frailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies, >50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were consistent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients. Summary: The PFP is a effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.

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Section: Unanswered Questionsmentioning

confidence: 99%

Section: Unanswered Questionsmentioning

confidence: 99%

Frailty and Long-Term Post-Kidney Transplant Outcomes

2019

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“…Frailty has recently gained the attention of nephrologists, transplant surgeons, and renal health-care professionals for its promise of identifying vulnerable older patients living with end-stage kidney disease (ESKD) [1-6]. Frailty, originally identified in community-dwelling older adults, is defined as a medical syndrome of multisystem dysregulation and is manifested as a compromised resistance to stressors that increases vulnerability to dependence and mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

et al. 2020

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Background: Frailty, originally characterized in communitydwelling older adults, is increasingly being studied and implemented for adult patients with end-stage kidney disease (ESKD) of all ages (>18 years). Frailty prevalence and manifestation are unclear in younger adults (18-64 years) with ESKD; differences likely exist based on whether the patients are treated with hemodialysis (HD) or kidney transplantation (KT).

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“…For example, a recent review of the literature by Cheng et al identified a growing body of evidence documenting improved outcomes in cardiopulmonary fitness with exercise training in patients after cardiothoracic and orthopedic surgeries, including post-cardiac transplantation [ 39 ]. There is also evidence that most nephrologists, geriatricians, transplant surgeons, and ESRD patients agree that prehabilitation could make ESRD patients less frail [ 40 ]. Because functional limitations can be improved through intervention, pre-KT risk assessment with the SPPB may provide an opportunity to intervene by encouraging patient participation in a prehabilitation program.…”

Section: Discussionmentioning

confidence: 99%

Pre-kidney transplant lower extremity impairment and transplant length of stay: a time-to-discharge analysis of a prospective cohort study

et al. 2018

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BackgroundFew objective tests can be performed at admission for kidney transplantation [KT] to discern risk of increased length of stay [LOS], which is important for patient counseling and is associated with increased costs and mortality. The short physical performance battery [SPPB] is an easily administered, potentially modifiable, 3-part test of lower extremity function. SPPB score is associated with longer hospital LOS in older adults, and may provide similar utility in KT recipients given that ESRD is a disease of accelerated aging. The aim of this study was to characterize the association between SPPB-derived lower extremity function and LOS.MethodsThe SPPB was administered at KT admission in a prospective cohort of 595 recipients (8/2009–6/2016). The independent association between SPPB impairment (score ≤ 10) and LOS was tested with an adjusted conventional generalized gamma parametric survival model.ResultsImpaired recipients experienced longer LOS (median: 10 vs. 8 days; P < 0.001) with the greatest difference in percent discharged on day 10 (impaired: 54.5%, unimpaired: 73.3%). Discharge typically took 13% longer in the impaired group (relative time = 1.13; 95%CI: 1.05, 1.21, P = 0.001). Discharge for impaired recipients compared to unimpaired was least likely at day 5 (hazard ratio = 0.71; 95% CI:0.68, 0.74, P < 0.001). No differences in the SPPB impairment-LOS relationship were found by age (interaction P = 0.74).ConclusionsPre-KT SPPB impairment was independently associated with longer LOS regardless of age, indicating that it is a useful, objective tool for pre-KT risk assessment in younger and older recipients that may help inform discharge planning.

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Engaging clinicians and patients to assess and improve frailty measurement in adults with end stage renal disease

Cited by 32 publications

References 28 publications

Frailty and Long-Term Post-Kidney Transplant Outcomes

Frailty and Long-Term Post-Kidney Transplant Outcomes

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

Pre-kidney transplant lower extremity impairment and transplant length of stay: a time-to-discharge analysis of a prospective cohort study

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