Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality
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2025
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| author | Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco |
| author_facet | Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco |
| collection | Wiley Open Access |
| contents | Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco Clinical Transplantation ABSTRACT Background Frail kidney transplant (KT) candidates, characterized by low physical activity/function, have decreased chances of listing and increased risk of waitlist mortality. Impairments in these physical domains contribute to perceived physical burden and may exacerbate one another. Further, understanding the association of each domain individually with adverse outcomes may improve pre‐KT risk stratification. Methods We leveraged 2708 KT candidates (age ≥ 18) from a two‐center prospective cohort study (2014–2024). We assessed physical activity (Minnesota Leisure Time Physical Activity Questionnaire), physical function (gait speed), and physical burden (10 questions from the Kidney Disease Quality of Life Short Form) at evaluation. We quantified the association of these three physical domains with listing (Cox proportional hazards) and waitlist mortality (competing risks, Harrell's C ‐statistic). Results Among 2708 candidates, 40% had low physical activity, 16% had low physical function, and 54% had high physical burden. Candidates with impairment in these three physical domains were less likely to be listed (activity: adjusted hazard ratio [aHR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; function: aHR = 0.54, 95%CI: 0.45–0.64; burden: aHR = 0.75, 95%CI: 0.67–0.83) and had a higher risk of waitlist mortality (activity: adjusted sub‐hazard ratio [aSHR] = 1.51, 95%CI: 1.11–2.04; function: aSHR = 1.83, 95%CI: 1.30–2.58; burden: aSHR = 1.40, 95%CI: 1.09–1.82). Physical burden showed the best discrimination in predicting mortality after adjustment (Harrell's C ‐statistic = 0.6899). Conclusion Although impairment in physical activity, function, and burden was all associated with KT listing and waitlist mortality, physical burden was the strongest predictor of waitlist mortality. KT centers should consider measuring physical burden – a simple, low‐cost tool to help identify high‐risk candidates for prehabilitation. 10.1111/ctr.70388 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70388 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70388 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco Clinical Transplantation Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality Nan‐Su Huang Jingyao Hong Akanksha Nalatwad Yiting Li Nidhi Ghildayal Nicole M. Ali Aarti Mathur Babak J. Orandi Dorry L. Segev Mara A. McAdams‐DeMarco Clinical Transplantation ABSTRACT Background Frail kidney transplant (KT) candidates, characterized by low physical activity/function, have decreased chances of listing and increased risk of waitlist mortality. Impairments in these physical domains contribute to perceived physical burden and may exacerbate one another. Further, understanding the association of each domain individually with adverse outcomes may improve pre‐KT risk stratification. Methods We leveraged 2708 KT candidates (age ≥ 18) from a two‐center prospective cohort study (2014–2024). We assessed physical activity (Minnesota Leisure Time Physical Activity Questionnaire), physical function (gait speed), and physical burden (10 questions from the Kidney Disease Quality of Life Short Form) at evaluation. We quantified the association of these three physical domains with listing (Cox proportional hazards) and waitlist mortality (competing risks, Harrell's C ‐statistic). Results Among 2708 candidates, 40% had low physical activity, 16% had low physical function, and 54% had high physical burden. Candidates with impairment in these three physical domains were less likely to be listed (activity: adjusted hazard ratio [aHR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; function: aHR = 0.54, 95%CI: 0.45–0.64; burden: aHR = 0.75, 95%CI: 0.67–0.83) and had a higher risk of waitlist mortality (activity: adjusted sub‐hazard ratio [aSHR] = 1.51, 95%CI: 1.11–2.04; function: aSHR = 1.83, 95%CI: 1.30–2.58; burden: aSHR = 1.40, 95%CI: 1.09–1.82). Physical burden showed the best discrimination in predicting mortality after adjustment (Harrell's C ‐statistic = 0.6899). Conclusion Although impairment in physical activity, function, and burden was all associated with KT listing and waitlist mortality, physical burden was the strongest predictor of waitlist mortality. KT centers should consider measuring physical burden – a simple, low‐cost tool to help identify high‐risk candidates for prehabilitation. 10.1111/ctr.70388 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70388 |