Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review

Area of Science:

• Nephrology
• Transplantation Medicine
• Geriatrics

Background:

• Frailty and functional decline are increasingly recognized as critical factors in kidney transplant candidates.
• Understanding the relationship between these conditions and post-transplant outcomes is essential but incomplete.
• The ideal measures for assessing functional status and frailty in this population remain undefined.

Purpose of the Study:

• To systematically review the association between pre-transplant frailty and functional status measures and adverse clinical outcomes after kidney transplantation.
• To identify commonly used instruments for assessing frailty and functional status in kidney transplant recipients.
• To synthesize evidence on the predictive value of these measures for key post-transplant events.

Main Methods:

• A systematic review of observational studies (cohort, case-control, cross-sectional) was conducted.
• Searches were performed in Medline, Embase, and Cochrane Central Register for Controlled Trials up to February 7, 2023.
• Data on demographic information, frailty/functional status assessments, and clinical outcomes were extracted and analyzed.

Main Results:

• Fifty studies were identified, utilizing 36 unique instruments to assess frailty and functional status.
• Frailty and lower functional status were consistently associated with an increased risk of mortality post-kidney transplant.
• Similar associations were observed for graft loss and hospital readmission, highlighting the predictive importance of these measures.

Conclusions:

• Pre-transplant frailty and functional status are significant predictors of adverse outcomes following kidney transplantation.
• The heterogeneity in measurement instruments and study designs limits data pooling and necessitates further investigation.
• Future research should focus on identifying optimal assessment tools and exploring interventional strategies, such as prehabilitation, to improve patient outcomes.