Priyadarshini Manay1, Patrick Ten Eyck2, Roberto Kalil3, Melissa Swee4, M Lee Sanders4, Grace Binns5, Jodell L Hornickel5, Daniel A Katz6. 1. Department of Surgery, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, IA. 2. Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA. 3. Department of Medicine, University of Maryland Medical Center, Baltimore, MD. 4. Department of Medicine, Division of Nephrology, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, IA; Veterans Affairs Medical Center, Iowa City, IA. 5. Veterans Affairs Medical Center, Iowa City, IA. 6. Department of Surgery, Organ Transplant Center, University of Iowa Hospitals and Clinics, Iowa City, IA; Veterans Affairs Medical Center, Iowa City, IA. Electronic address: daniel-katz@uiowa.edu.
Abstract
BACKGROUND: Experience incorporating frailty and functional metrics in the transplant evaluation process is limited. We hypothesized that simple tests correlate with kidney transplant listing outcomes. METHODS: Frailty metrics, treadmill ability, pedometer data, troponin T, and brain natriuretic peptide were collected on 375 consecutive kidney transplant evaluations between July 2015 and December 2018. Patients initially denied were compared with those listed or deferred. Frailty metrics included handgrip, chair sit-stand, up-and-go, chair sit-reach, and questions related to exhaustion. RESULTS: A total of 95 (25%) patients were initially denied. Those denied were older, diabetic, or had higher body mass indexes. Frailty metrics including chair sit-stand, up-and-go, chair sit-reach, grip strength, and exhaustion; biochemical markers troponin and brain natriuretic peptide; and pedometer and treadmill ability were all significantly associated with denial (P < .001). The best order three model combining parsimony and predictiveness included treadmill ability, exhaustion, and troponin. The most predictive pedometer model also included exhaustion and up-and-go. The best order three model excluding biochemical markers, pedometer, and treadmill results included up-and-go, exhaustion, and chair sit-reach. CONCLUSION: Outcomes after on-site kidney transplant evaluation strongly correlated with the results of common clinical and functional frailty metrics.
BACKGROUND: Experience incorporating frailty and functional metrics in the transplant evaluation process is limited. We hypothesized that simple tests correlate with kidney transplant listing outcomes. METHODS: Frailty metrics, treadmill ability, pedometer data, troponin T, and brain natriuretic peptide were collected on 375 consecutive kidney transplant evaluations between July 2015 and December 2018. Patients initially denied were compared with those listed or deferred. Frailty metrics included handgrip, chair sit-stand, up-and-go, chair sit-reach, and questions related to exhaustion. RESULTS: A total of 95 (25%) patients were initially denied. Those denied were older, diabetic, or had higher body mass indexes. Frailty metrics including chair sit-stand, up-and-go, chair sit-reach, grip strength, and exhaustion; biochemical markers troponin and brain natriuretic peptide; and pedometer and treadmill ability were all significantly associated with denial (P < .001). The best order three model combining parsimony and predictiveness included treadmill ability, exhaustion, and troponin. The most predictive pedometer model also included exhaustion and up-and-go. The best order three model excluding biochemical markers, pedometer, and treadmill results included up-and-go, exhaustion, and chair sit-reach. CONCLUSION: Outcomes after on-site kidney transplant evaluation strongly correlated with the results of common clinical and functional frailty metrics.
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