Frailty and Sarcopenia in Older Patients Receiving Kidney Transplantation

Abstract

Kidney transplantation is the treatment of choice for most of the patients with end-stage renal disease (ESRD). It improves quality of life, life expectancy, and has a lower financial burden to the healthcare system in comparison to dialysis. Every year more and more older patients are included in the kidney transplant waitlist. Within this patient population, transplanted subjects have better survival and quality of life as compared to those on dialysis. It is therefore crucial to select older patients who may benefit from renal transplantation, as well as those particularly at risk for post-transplant complications. Sarcopenia and frailty are frequently neglected in the evaluation of kidney transplant candidates. Both conditions are interrelated complex geriatric syndromes that are linked to disability, aging, comorbidities, increased mortality, and graft failure post-transplantation. Chronic kidney disease (CKD) and more importantly ESRD are characterized by multiple metabolic complications that contribute for the development of sarcopenia and frailty. In particular, anorexia, metabolic acidosis and chronic low-grade inflammation are the main contributors to the development of sarcopenia, a key component in frail transplant candidates and recipients. Both frailty and sarcopenia are considered to be reversible. Frail patients respond well to multiprofessional interventions that focus on the patients' positive frailty criteria, while physical rehabilitation and oral supplementation may improve sarcopenia. Prospective studies are still needed to evaluate the utility of formally measuring frailty and sarcopenia in the older candidates to renal transplantation as part of the transplant evaluation process.

Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics

“…High BMI level at the time of transplantation is associated with increased risk of posttransplant mortality, graft failure, delayed graft function, and other surgical complications 5‐7 . Low BMI levels have also been shown as a risk factor for diminished posttransplant outcomes, which in some cases may relate to frailty and sarcopenia 8‐11 . Cumulatively, there is a well‐established “J‐Shaped” curve characterizing risks associated with BMI for kidney transplant recipients.…”

Nutrition-Based Management of Inflammaging in CKD and Renal Replacement Therapies

“…The choice of a nutrition able to fulfill these indications and support immune response is referred to as immune-nutrition, and different approaches have been studied to understand its possible effects [ 171 ]. In this effort, a tailored nutritional support, if associated with physical exercise [ 172 ], could guarantee a good nutritional status for ESRD patients and possibly reverse the clinical signs of frailty and musculoskeletal senescence [ 173 ].…”

Impact of kidney transplantation on functional status

“…Current guidelines do not specify a quantitative threshold for “frailty” at which a patient could be at higher risk for adverse post-transplant outcomes [ 13 , 14 ]. Recent Kidney Disease and Improving Global Outcomes (KDIGO) guidelines recommend evaluation of frailty at the time of listing and while being on the waitlist in order to determine transplant candidacy; however, no cut-off values have been proposed to date [ 15 , 16 ]. The results of our study could contribute to such a guideline discussion and form a base for future recommendations.…”