Frailty Testing Pilot Study: Pros and Pitfalls

BACKGROUND: Frailty can be defined as an inflammatory state with a loss of physiologic reserve in multiple systems that manifests as a decreased ability to respond to stressors that ultimately leads to an increased risk of adverse outcomes. The aim of this study was to determine the ease of frailty testing in a pre-kidney transplant clinic and the resources required to do so. A secondary goal was to better understand the utility of frailty testing when evaluating potential kidney transplant recipients. METHODS: Frailty testing was conducted at a pre-kidney transplant clinic in three phases using Fried’s frailty phenotype (shrinking, exhaustion, low physical activity, slowness, and grip strength). RESULTS: A total of 132 frailty tests were completed on 128 patients. Frail patients had significantly higher rates of shrinking (26% vs. 8.5%, P < 0.05), exhaustion (82.6% vs. 27.6%, P < 0.05), low physical activity (78.2% vs. 19.0%, P < 0.05), slow walking (60.8% vs. 15.2%, P < 0.05), and grip strength (73.9% vs. 25.7%, P < 0.05). When comparing the listing of frail and non-frail patients for transplant, a significantly lower proportion of frail patients were listed compared to non-frail patients (30.4% vs. 57.6%, P < 0.05). Frailty testing was most complete when an examiner dedicated to frailty testing performed the testing. CONCLUSIONS: Frailty testing is feasible to complete in a pre-transplant clinic with an appropriate investment in personnel and resources.