Appendix Table 1:
AST Frailty Working Group Survey of US Adult KT Centers
| Survey Questions | Response | |
|---|---|---|
| Format | Options | |
| Please indicate your provider type | Select one from drop-down | Transplant
Nephrologist Transplant Surgeon Transplant Coordinator Nurse/PA/NP Pharmacist Social Worker Other (open text) |
| What is your transplant center’s UNOS code? Please use the following link to look up your code if you do not know it. | Free text | 4 digit UNOS Code |
| Frailty Perception Questions | ||
| In your view, is frailty a useful concept in evaluating candidacy for kidney transplantation? | Select one | Yes No |
| In defining frailty, which of the following features are important to consider: | Rank with “1” being most important | Functional limitation (e.g. walking
speed, grip strength, sarcopenia) Morbidity (e.g. diabetes mellitus) Psychosocial status (e.g. depression or anxiety) Cognitive ability (e.g. memory or attention) |
| In your view, what components are
essential in assessing
frailty? • Grip strength • Gait speed • Sit to stand • Exhaustion • Unintentional weight loss • Low physical activity • Cognitive function • Mood • Skeletal muscle mass • Laboratory markers • Need for ADL assistance • Other (please specify) |
Select one | Important Less Important |
| Do you think the results of a frailty assessment should be used to influence decisions regarding candidate selection for transplantation (i.e. determination of medical appropriateness)? | Select one | Yes (please explain) No (please explain) |
| In your area of practice, do you think frailty in transplant candidates is a risk factor for adverse outcomes before transplantation (e.g. waiting list mortality)? Please explain. | Select one | Yes (please explain) No (please explain) |
| Do you think the results of a frailty assessment should be used to influence decisions regarding the timing of transplantation (i.e. determination of medical urgency)? Please explain. | Select one | Yes (please explain) No (please explain) |
| In your area of practice, do you think frailty in transplant candidates is a risk factor for adverse outcomes after transplantation (e.g. affecting length of stay or post-transplant mortality)? Please explain. | Select one | Yes (please explain) No (please explain) |
| What interventions before transplantation do you think are useful to improve frailty? | Rank with “1” being most useful | Optimization of dialysis/fluid
status Nutrition stimulation or supplements Physical therapy Psychotherapy |
| If you consider frailty reversible, how do you monitor reversibility? | Free text | |
| In your view, should there be a distinction between “irreversible” frailty, denoting frailty that is not directly due to end-stage organ failure, and “reversible” frailty, that is likely to improve after transplantation? Please explain. | Select one | Yes (please explain) No (please explain) |
| In your view, is there a pathophysiological distinction between biological aging and frailty? Please explain. | Select one | Yes (please explain) No (please explain) |
| In your view, should biological age be considered in assessing frailty? (Is frailty in the young less concerning than frailty in those of advanced age?) Please explain. | Select one | Yes (please explain) No (please explain) |
| In your view, is there a need for the development of a frailty score in the setting of kidney transplantation? Please explain. | Select one | Yes (please explain) No (please explain) |
| Please feel free to add any additional comments. | Free text | |
| Frailty Practice Questions | ||
| Do you currently perform a standardized frailty assessment as part of evaluation for kidney transplant candidacy in your practice? Please explain. | Select one | Yes- always (please
explain) Yes- sometimes (please explain) No-never (please explain) Not sure |
| Do you currently perform a standardized frailty assessment for kidney transplant recipients at the time of transplantation in your practice? Please explain. | Select one | Yes- always (please
explain) Yes- sometimes (please explain) No-never (please explain) Not sure |
| If you do not measure frailty, are you interested in measuring frailty among your KT candidates and recipients? | Select one | Yes No |
| If you currently perform a frailty assessment as part of evaluation for kidney transplant candidacy at your center, who performs the assessment? | Select one | Nurse Nutritionist Occupational Therapist Physical Therapist Respiratory Therapist Physician We do not perform frailty assessments as part of evaluation I don’t know Other (please specify) |
| If you currently perform a frailty assessment as part of for kidney transplant recipients at the time of transplantation at your center, who performs the assessment? | Select one | Nurse Nutritionist Occupational Therapist Physical Therapist Respiratory Therapist Physician We do not perform frailty assessments as part of evaluation I don’t know Other (please specify) |
| What tool for the assessment of frailty do you currently use routinely? | Check all that apply | Fried Frailty
Phenotype Rockwood Clinical Frailty Scale Short Physical Performance Battery Deficit Index (DAI, also called Frailty Index) Montreal Cognitive Assessment Cognitive function (i.e. 3MS, MMSE, or Trail Making Test) Functional status (i.e. KDQOL, SF-36, or PCS) Level of sarcopenia Body Mass Index to quantify wasting Number of hospitalizations in the previous year Gill Frailty Measure Frailty/Vigor Assessment Brief Frailty Instrument Vulnerable Elders Survey FRAIL Scale Stair Climbing Assessment Winograd Screening Instrument Timed Up and Go Timed walk (i.e. 6-minute walk test) Distance walk test (i.e. 10-meter walk test) Geriatric Assessment Assessment by a physical therapist Other (Please specify) Don’t know |
| In which candidates do you perform these assessments? | Select one | Just older candidates (please
indicate age cut point) All candidates Other (Please explain) Don’t know |
| In addition to age, what comorbidities are considered when identifying individuals who should undergo measures of frailty? | Select one | None Cardiovascular Diabetes History of a stroke Dialysis vintage Obesity Other (Please specify) Don’t know |
| Is this information presented at selection committee? | Select one | Yes No |
| How else are these assessments used? | Check all that apply | Decisions about listing a
patient Decisions about transplanting a patient Decisions to proceed with a living donor transplant Decisions about accepting a high KDPI organ offer Decisions on whether or not to use induction therapy Decisions on which induction therapy to use Decisions to tailor immunosuppression Decisions about prehabilitation prior to KT Determination of the amount of social/home support required prior to listing Quality improvement/research Other (Please specify) |
| If a KT candidate or recipient (of
any age) is frail, how likely are you to make the following
decisions? • List for transplant • Perform deceased donor transplant • Perform living donor transplant • Accept a high KDPI organ offer • Use induction therapy • Tailor maintenance immunosuppression • Prescribe prehabilitation prior to KT • Increase amount of social/home support required prior to listing • Other |
Select one | More likely About the same Less likely Frailty is an absolute contraindication to this action |
| Is there anything else you would like us to know about assessing frailty at your center? | Free text | |