Functional independence, access to kidney transplantation and waitlist mortality

Area of Science:

• Nephrology
• Geriatrics
• Transplant Surgery

Background:

• End-stage kidney disease (ESKD) patients on dialysis often face functional decline, impacting mortality and institutionalization.
• The functional independence of kidney transplant (KT) candidates, a healthier subset of ESKD patients, is not well understood.
• Investigating functional independence in KT candidates is crucial for understanding access to transplantation and waitlist outcomes.

Purpose of the Study:

• To determine the prevalence of functional independence in Activities of Daily Living (ADL) and Instrumental ADL among KT candidates.
• To examine the association between functional independence and kidney transplant listing rates.
• To assess the relationship between functional independence and waitlist mortality and transplant rates.

Main Methods:

• Prospective cohort study of 3168 ESKD participants from January 2009 to June 2018.
• Self-reported functional independence in basic ADLs (eating, dressing, etc.) and complex IADLs (shopping, managing finances, etc.).
• Statistical analysis using Cox models, competing risks, and Poisson regression to estimate associations.

Main Results:

• A high percentage of KT candidates were independent in ADLs (92.4%), but fewer were independent in IADLs (68.5%).
• ADL independence was significantly associated with a higher likelihood of KT listing (aHR=1.55) and KT rates (aIRR=1.58).
• ADL independence correlated with reduced waitlist mortality (aSHR=0.66), while IADL independence showed no significant association.

Conclusions:

• Functional independence in basic self-care (ADLs) is a key factor for improved kidney transplant access and reduced waitlist mortality.
• Healthcare professionals should assess ADL function in KT candidates.
• Interventions promoting ADL independence may enhance transplant outcomes for ESKD patients.