Frailty and the Kidney Transplant Wait List: Protocol for a Multicenter Prospective Study

Area of Science:

• Nephrology
• Transplantation Medicine
• Geriatrics

Background:

• Frailty's impact on transplant outcomes is a critical research gap.
• Previous studies have not evaluated frailty in a large Canadian multicenter cohort of wait-listed patients.

Purpose of the Study:

• To determine if frailty is associated with death or permanent withdrawal from the kidney transplant wait list.
• To assess frailty's association with hospitalization, quality of life, and wait-list acceptance probability.

Main Methods:

• Prospective cohort study involving individuals evaluated for the kidney transplant wait list across seven Canadian centers.
• Frailty assessed using Fried Phenotype, frailty index, Short Physical Performance Battery, and Clinical Frailty Scale.
• Primary outcome: composite of death or permanent wait-list withdrawal, accounting for transplantation as a competing risk.

Main Results:

• 665 frailty assessments completed by December 2019, including primary and secondary outcomes.
• Study designed to provide >80% power to detect a hazard ratio of ≥1.7 for frail vs. non-frail patients.

Conclusions:

• Findings will elucidate the association between frailty and outcomes for wait-listed patients.
• Understanding this association is crucial before routine frailty screening and intervention development for transplant candidates.