Dr CLARE LESLIE1, Dr AMY BARNETT1,2, A/Prof ROSEMARY MASTERSON1, A/Prof PETER HUGHES1
1Royal Melbourne Hospital, Parkville, Australia, 2Western Health, St Albans, Australia
Biography:
Dr. Clare Leslie is a basic physician trainee at the Royal Melbourne Hospital with a particular interest in global health and plans to pursue a career in nephrology.
Aim:
To describe the prevalence and clinical associations of frailty, as measured by the Short Physical Performance Battery (SPPB), among kidney transplant candidates in a real-world setting.
Background:
Frailty is increasingly recognised as a predictor of adverse outcomes following kidney transplantation. However, routine screening remains uncommon due to feasibility issues with existing tools and a lack of consensus on optimal assessment methods. The SPPB measures balance, gait speed and chair stand performance, and has shown promise in evaluating frailty in other populations with end-organ failure.
Methods:
This single-centre retrospective cohort study included 124 kidney transplant candidates who were referred for nurse-led SPPB testing based on clinical concerns about frailty. Testing was performed on the day of their scheduled transplant assessment appointment.
Results:
The median age was 63 years (IQR 57-68), 40% were women and diabetic kidney disease was the most common cause of kidney failure (34.7%). Using a validated total SPPB cut-off score of ≤10, frailty was identified in 72.6% of the cohort. Lower SPPB scores, indicating greater frailty, were significantly associated with diabetes (p <0.0001), but not age, weight or gender. Lower scores were also associated with a reduced likelihood of subsequent transplantation (p=0.007) and increased overall mortality (p=0.02). Compared to patients who underwent transplantation, those who remain under evaluation were significantly more frail at baseline (p=0.041). Multivariate analyses were not performed due to the limited number of outcome events – 14 transplants and 19 deaths.
Conclusion:
In this high-risk cohort, SPPB-measured frailty was common and associated with lower transplantation rates and increased mortality. These findings support the potential utility of SPPB-based pre-transplant frailty assessment, but require prospective validation in larger, unselected populations.
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