Older patients with end- stage kidney disease (ESKD) are at very high risk for functional impairment. Kidney transplantation has the potential to ameliorate the detrimental effects of ESKD on physical activity and functional status. However, kidney transplantation alone may not meet the full extent of this potential, particularly for older or more impaired adults. In fact, activity declines immediately post-kidney transplantation and fails to return to expected levels even 5 years post-kidney transplantation. Older patients waitlisted for kidney transplantation (most of whom are on dialysis) are therefore reliant on their pre-kidney transplantation levels of exercise, which are also predictive of post-kidney transplantation mortality.
“Prehabilitation” has been used in other surgical populations to minimize functional loss, and a structured exercise program may be beneficial in the pre- KT setting. However, few waitlisted patients are able to participate in typical exercise interventions due to barriers such as severe fatigue. Older patients have additional barriers such as further mobility impairment and requiring substantial caregiver support. We have previously designed an exercise intervention for dialysis patients regardless of waitlist status or age. However, in order to appropriately adapt this intervention for older living donor kidney transplant candidates our current research addresses issues such as specifics of coaching, timing, and importantly, how to incorporate caregiver participation.
We are currently adapting our exercise algorithm in preparation for a randomized controlled trial of a Structured Program of exercise for Recipients of Kidney Transplantation (SPaRKT) in older adults awaiting living donor kidney transplantation, trialing the the exercise program as compared to usual care. Future studies will define the appropriate level of resources necessary for prehabilitation (e.g., frequency of health coaching, nutritional support) and broaden the program to recipients of deceased donor kidneys.
