Frailty Prevalence and Characterization Among Kidney Transplant Candidates in Spain: A Multicenter Study

Frailty is a frequent condition among kidney transplant candidates (KTc) that confers poor outcomes after transplantation. We aimed to establish frailty prevalence in a representative sample of KTc in Spain. We conducted a multicenter cross-sectional study including 1194 KTc ≥50 years. Frailty was assessed by the FRAIL scale. Mean age was 64.2 years; 38.4% were female. Median Charlson comorbidity index (CCI) was 6 [4-7] and the total number of medications was 9 [7-12]. We found that 8.2% of patients were frail and 41.5% were pre-frail. Frailty was more frequent among females (60.2% of frail vs. 32.8% of robust; p < 0.001), hemodialysis patients (74.5% of frail vs. 67.1% of robust; p = 0.02), and those with a high burden of disease (54.6% of frail patients with CCI >6 vs. 29.3% of robust; p < 0.001). The multivariable analysis confirmed that frailty was associated with the female sex (OR 3.9 [2.5-6.2]); higher CCI (>6 OR 2.9 [1.6-54]); and the number of medications (OR -per medication- 1.13 [1.07-1.2]). Almost 50% of KTc in Spain are pre-frail or frail. Frailty is more prevalent between women and patients with high comorbidity burden. Identifying those candidates at risk is essential to establish risks and implement strategies to minimize them.