Prevalence of frailty and cognitive impairment in older transplant candidates - a preview to the Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study

Abstract

Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. Methods The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post-transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable were also eligible for enrolment into the qualitative sub-study. Results Two hundred eight participants have been recruited (age 60–78). Baseline Montreal Cognitive Assessments were available for 173 participants, with 63 (36.4%) participants identified as having scores below normal (score < 26). Edmonton Frail Scale assessments were available for 184 participants, with 29 participants (15.8%) identified as frail (score ≥ 8), and a further 37 participants (20.1%) identified as being vulnerable (score 6–7). Conclusion In the KTOP study cohort we have identified a prevalence of 36.4% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 15.8% at recruitment. A further 20.1% were vulnerable. As formal testing for cognition and frailty is not routinely incorporated into the work up of older people across many units, the presence and significance of these conditions is likely not known. Ultimately the KTOP study will report on how these parameters evolve over time and following a transplant, and describe their impact on quality of life and clinical outcomes.

Maximizing opportunities for kidney transplantation in older adults

“…transplantation [23][24][25][26][27]. Although frailty may be identified in younger individuals on dialysis, advancing age tends to correlate with increasing frailty [28,29]. Several frailty evaluation tools are available including the Fried Physical Frailty Phenotype (PFP) [30].…”

“…Physiologic frailty, defined as diminished strength, endurance, and reduced physiologic function, is increasingly recognized as an important marker of the risk of mortality and graft loss after kidney transplantation [23–27]. Although frailty may be identified in younger individuals on dialysis, advancing age tends to correlate with increasing frailty [28,29]. Several frailty evaluation tools are available including the Fried Physical Frailty Phenotype (PFP) [30].…”

Screening of cognitive performance in kidney transplant recipients: a mini review

“…found an adjusted odds ratio (OR) of 1.33 for cognitive impairment per every 10-year increase in age ( 1 ). Other factors that have been independently associated with cognitive impairment in KTRs are lower education level ( 2 , 4 , 14 ), lower eGFR ( 4 ), diabetes ( 2 ), more years on dialysis ( 2 ), hypertension ( 4 ), frailty ( 15 ), depressive symptoms, and less capability regarding the activities of daily living ( 14 ) ( Table 2 ). However, the results among the studies are far from consistent.…”

“…Studies measuring cognition at admission to kidney transplantation ( 14 , 25 ) assess performance under pre-dialysis or dialysis conditions. In the first days and weeks after transplantation, surgery-related burdens, high doses of centrally acting drugs, infectious complications, psychological strains, and changing levels of renal function, volume status, and electrolytes often predominate.…”

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

“…The aims of this study were therefore to (1) describe how QoL and patient reported experience in older kidney transplant candidates varies by frailty status, and (ii) investigate the relationship between components of the Edmonton Frail Scale (EFS) and patient experience scores. This work is a secondary analysis within the wider Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study ( 19 ).…”