Patient Perspectives on the Use of Frailty, Cognitive Function, and Age in Kidney Transplant Evaluation

Shrestha, Prakriti; Rasmussen, Sarah E. Van Pilsum; Fazal, Maria; Chu, Nadia M.; Garonzik-Wang, Jacqueline M; Gordon, Elisa J.; McAdams‐DeMarco, Mara; Humbyrd, Casey Jo

doi:10.1080/23294515.2022.2090460

Cited by 10 publications

(10 citation statements)

References 51 publications

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“…Listing decisions should weigh the totality of evidence, including frailty, when deciding whether to list a patient. Frailty should never be used as the sole reason for disqualifying a patient for KT, as is supported by patients and experts [ 69 , 70 ]. Frailty is particularly useful when deciding to list an older candidate such that robust older adults should be listed regardless of their age.…”

Section: Pro: Validated Frailty Assessment Is Essential To Maximize T...mentioning

confidence: 99%

Frailty assessment as part of transplant listing: yes, no or maybe?

McAdams‐DeMarco

Thind

Nixon

et al. 2022

Clinical Kidney Journal

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Frailty, characterized by a decreased physiological reserve and an increased vulnerability to stressors, is common among kidney transplant (KT) candidates and recipients. In this review, we present and summarise the key arguments for and against the assessment of frailty as part of KT evaluation. The key arguments for including frailty were: 1) sheer prevalence and far-reaching consequences of frailty on KT, and 2) ability to conduct a more holistic and objective evaluation of candidates, removing the inaccuracy associated with ‘eye-ball’ assessments of transplant fitness. The key argument against were: 1) lack of agreement on the definition of frailty and which tools should be used in renal populations, 2) a lack of clarity on how, by whom, and how often frailty assessments should be performed, and 3) a poor understanding of how acute stressors affect frailty. However, it is the overwhelming opinion that the time has come for frailty assessments to be incorporated into KT listing. Although ongoing areas of uncertainty exist and further evidence development is needed, the well-established impact of frailty on clinical and experiential outcomes, the invaluable information obtained from frailty assessments, and the potential for intervention, outweighs these limitations. Proactive and early identification of frailty allows for individualised and improved risk assessment, communication, and optimisation of candidates.

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Section: Pro: Validated Frailty Assessment Is Essential To Maximize T...mentioning

confidence: 99%

Frailty assessment as part of transplant listing: yes, no or maybe?

McAdams‐DeMarco

Thind

Nixon

et al. 2022

Clinical Kidney Journal

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“…However, behavioral interventions are common, and though not well studied in SOT populations, preliminary data and evidence from other chronic disease patient populations suggest protective effects. A common strategy of SOT clinical providers is mobilization of patient social supports so that the support system is aware of the patient cognitive impairment and can help when and where needed [60 ▪▪ ,61 ▪▪ ,67 ▪ ,68–70]. Preliminary data suggest this type of strategy may reduce hospital readmissions in the preheart transplant period [67 ▪ ], but fully-powered controlled trials are needed to confirm.…”

Section: Current Clinical Management Of Cognitive Impairmentmentioning

confidence: 99%

Current recommendations regarding evaluation of cognitive functioning in organ transplant candidates

Jesse

Haver

2022

Current Opinion in Organ Transplantation

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Purpose of reviewCognitive impairment is associated with negative effects on solid organ transplant candidates, recipients, and their care partners. However, because of the heterogeneity of mechanisms, presentations, and assessment measures, research suggests a wide array of impairments, patterns of impairments, and unclear trajectories posttransplant. This review provides an abbreviated synthesis of recent research on cognitive impairments observed in organ-eligible candidates and potential trajectories through posttransplant, current clinical recommendations regarding integration of assessment into routine clinical transplant practice, as well as recommendations for future research. Recent findingsTransplantation may resolve certain disease-contributing factors to cognitive impairments but also introduces new potential neurocognitive assaults. Recent studies in kidney and lung recipients document continued impairments in subsets of patients, particularly those identified as frail. For liver candidates, new assessment measures of hepatic encephalopathy have been developed and preliminarily tested with potential for translation into routine clinical care. Clinical implications, as well as ethical considerations are discussed.

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“…The classical definition of frailty is as a syndrome of decreased physiologic reserve characterized by functional decline in different physiological systems and reduced capacity to resist to stressors (2,3). The data collected by Greinert et al confirms that frailty is associated with some indicators of reduced healthy condition, like increased risk of falls, hospitalizations, CI, reduced HRQoL, and even mortality (4).…”

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confidence: 96%

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confidence: 99%

“…Yet things are not so straightforward. In fact, data indicate that ‘Frailty is more prevalent among older hemodialysis patients, KT candidates, and KT recipients; however, there is a high prevalence of frailty among younger patients as well’ [ 3 ]. Furthermore, the fact that post-transplant outcome is overall worse for frail patients is importantly counterbalanced by the fact that sometimes frailty is improved in transplanted patients.…”

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confidence: 99%

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The need for a multi-disciplinary reflection about frailty and cognitive impairment in chronic kidney disease

Farisco

Zecchino

Capasso

2022

Nephrology Dialysis Transplantation

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The paper by Robin Greinert et al.(1) touches upon a topic that is increasingly attracting interest from different perspectives (e.g., neurology, nephrology, ethics), but that at the same time is still in need of more focused and deeper analysis. To illustrate its relevance, the connection between chronic kidney disease (CKD) and cognitive impairment (CI) is the subject of an ongoing COST Action (CONNECT, Cognitive Decline in Nephro-Neurology, https://connectcost.eu/) which is devoted to clarify the causal mechanisms of cognitive decline in CKD in order to improve its clinical treatment, both in terms of prevention and care .

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Patient Perspectives on the Use of Frailty, Cognitive Function, and Age in Kidney Transplant Evaluation

Cited by 10 publications

References 51 publications

Frailty assessment as part of transplant listing: yes, no or maybe?

Frailty assessment as part of transplant listing: yes, no or maybe?

Current recommendations regarding evaluation of cognitive functioning in organ transplant candidates

The need for a multi-disciplinary reflection about frailty and cognitive impairment in chronic kidney disease

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