Are You Strong Enough for a New Kidney?

Kidney transplant outcomes predicted by simple bedside test

(RxWiki News) A kidney transplant can save the life of a person with kidney failure. But treatment for kidney failure does not end after the patient gets a new organ. Doctors must continue working to make sure the new kidney works.

A quick and easy bedside test seems to be the best way to judge how well kidney disease patients' bodies will react to their new organs.

"Have your doctor run a frailty test before kidney transplant surgery."

In a recent study, Dorry L. Segev, M.D., Ph.D., of Johns Hopkins University School of Medicine, and colleagues found that a test usually used to measure the frailty of elderly patients may also be a useful tool for patients of all ages about to undergo kidney transplant surgery.

According to Dr. Segev, the medical definition of frailty is a lessened ability to withstand stress to the body and a low level of physiologic reserve - or when your body runs out of energy to perform normal physiological functions.

The frailty test developed at Johns Hopkins identifies someone as frail if they meet at least three of the following measures: unintentional weight loss of at least 10 pounds within the last year; reduced grip strength; exhaustion, or reduced effort and motivation; low levels of physical activity; and a slowed walking speed.

"Few current measures are accurate in predicting kidney transplant success, but we think we have identified one that works incredibly well," says Dr. Segev.

"A few years ago, we showed that a frailty score is a simple, yet powerful, bedside tool to predict surgical outcomes in elderly patients and now it seems it can do the same for younger patients with chronic diseases like kidney failure."

From their study of 183 patients about to undergo kidney transplant surgery, the researchers found that one quarter of the transplant patients were classified as frail.

These frail patients had almost twice the risk of early problems with their new kidneys, compared to those who were not classified as frail. Early problems are a signal that the new kidneys are more likely to fail further down the road.

No matter the age of the patient, transplant recipients who were classified as frail had this increased risk of problems with their new organs.

Early problems with a transplanted kidney do not mean that the kidney will never work. The transplanted kidney can recover. However, Dr. Segev explains that a new kidney with early problems is not likely to work as long as a kidney that starts working more quickly.

The researchers found delayed transplant function in 30 percent of patients who were classified as frail, compared to only 15 percent of those who were not deemed frail.

"This information tells us how long the kidney will likely last and how to best treat the patient," says Dr. Segev. "Our ability to predict delayed function of a new kidney should help overcome one of the biggest barriers to improving outcomes in transplant right now."

This study - which received support from a Clinical Scientists Development Award from the Doris Duke Charitable Foundation - is published in the Archives of Surgery.