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Frailty Assessment in an Aging Mouse Model

Frailty Assessment in an Aging Mouse Model

Published on: September 23, 2025

Karnofsky Performance Score-Failure to Thrive as a Frailty Proxy?

Margaret R Stedman¹, Daniel J Watford¹, Glenn M Chertow¹

¹Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA.

Transplantation Direct

|June 14, 2021

Summary

The Karnofsky Performance Status (KPS) scale shows poor reliability among kidney transplant candidates, with significant score variability and low interrater agreement. This unreliability raises concerns for its use in assessing transplant eligibility and frailty.

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Published on: July 24, 2013

Area of Science:

Nephrology
Transplantation Science
Medical Statistics

Background:

The Karnofsky Performance Status (KPS) scale is utilized as a proxy for frailty and a predictor of outcomes in kidney transplant candidates.
KPS is a mandatory metric for the Organ Procurement and Transplantation Network (OPTN) in the United States.
Concerns exist regarding the KPS scale's limitations and its influence on transplant eligibility decisions.

Purpose of the Study:

To investigate the variability, reliability, and trends of KPS reporting in patients awaiting kidney transplantation.
To assess the interrater reliability of the KPS scale in this patient population.

Main Methods:

An observational study design was employed using data from the Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2020.
Analysis included 8197 kidney transplant candidates with multiple KPS scores recorded within a 3-month period.
Interrater reliability was assessed using both the original 10-point scale and a condensed 4-category scale.

Main Results:

A total of 8197 kidney transplant candidates were analyzed, with 2-7 KPS scores per patient.
Significant variability in KPS reporting was observed, with 27% of patients showing score differences of 20-80 points.
Interrater reliability on the 10-point scale was poor (30%), and 38% of patients had at least a 1-category shift on a condensed scale.

Conclusions:

The study highlights substantial unreliability in KPS reporting among kidney transplant candidates.
The observed variability and poor interrater reliability raise significant concerns about using KPS as a definitive measure of frailty.
These findings question the appropriateness of KPS as a sole metric for evaluating kidney transplant candidacy.