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Kidney transplantation in older adults: new research highlights need for social support

20 November 2023

Study results presented at the UK Kidney Week conference held in Newport, Wales on 3-5 June 2023, offer new insights into how we might improve the experiences of older patients with end stage kidney disease considering transplantation.

A closer look at the views of older adults with end stage kidney disease

As the number of older people receiving a donor kidney has increased, the need for improved understanding of how this surgery impacts those aged greater than 60 years has become more urgent.  Kidney Transplantation in Older People (KTOP), supported by a Kidney Research UK-Stoneygate research project grant, aims to understand the effect of frailty on outcomes following a kidney transplant in this patient group. 

What is frailty? 

Frailty is related to ageing and becomes more common with declining kidney function. Being frail is characterised by impaired muscle strength and fatigue.  People with frailty have lower resilience to events such as infections or surgery and are at higher risk of falls, infections, admissions to hospital, longer stays in hospital and need for long-term care. Frailty can be measured in a number of ways, but most commonly by assessing the amount of help people need for common daily activities such as dressing. 

A group of males and females sanding in front of a presentation screen.
KTOP investigator team

Led by Professor Edwina Brown and Dr Michelle Willicombe from Imperial College London, KTOP will also support an improved understanding of the unique challenges faced by this patient group relating to their expectations and experiences of living with a donor kidney.

“The decision to transplant a kidney should be a shared one, and so we need to understand the views of all patients. KTOP will provide important information to support this in adults aged over 60 with additional health considerations. Professor Brown

Introducing KTOP 

KTOP is a survey and interview-based study including participants aged 60 years or greater, who were at particular risk of poor outcomes (known as ‘frailty’), receiving dialysis and active on the national kidney transplant waiting list. This study investigates older peoples' experiences of transplantation, alongside their quality of life before and after a kidney transplant, capturing their views of life as they progress from dialysis to life with a donor kidney. 

Patients enrolled in KTOP completed surveys and those who were at risk of being frail or frail were also interviewed. The surveys and interviews were done when they joined the study, and at 12 months for those on dialysis. Individuals who received a donor kidney were interviewed at 3 and 12 months after their operation. Two-hundred and ten patients joined KTOP and completed the surveys, 118 of whom had a transplant. Twenty-one of the patients also completed the interviews,  10 of whom had a transplant.   

Results show important predictors of a positive transplant experience

Professor Brown and her team found that whilst waiting for a transplant, levels of frailty stayed the same in most patients, but mental and physical quality of life was different in those who were frail/at risk and those who were not. The survey results related to life after a transplant are still to come. In the interviews with those who had a transplant, patients reported some relief from the burden of dialysis appointments, and an increase in the amount of time available to spend with others. Those with a good social network, spiritual beliefs and positive worldview were better able to cope with transplantation, while individuals with a lower support network had greater responsibility for self-care, reporting different challenges to dialysis. The research team noted that Covid-19 played a critical role in limiting social interactions and experiences outside the home, reducing opportunities for physical activities.   

Professor Brown commented “Receiving a transplant does not always lead to improved quality of life in frail older people, and strong social support is crucial for good outcomes. KTOP has shown that to improve services for older people we must consider their health status alongside the support networks in place.” 

Mary McCaul, Kidney Research UK's programme lead for transforming treatments noted, “The KTOP study increases understanding of how transplantation transforms older people’s lives. It follows changes in frailty in over 60’s on the journey from waiting list to life after transplant and the link with outcomes. Crucially, it helps us grasp the impact on the whole person, helping us grasp the implications on a person’s life and wellbeing afterwards.”

Next steps for KTOP

The final survey results from patients who had a transplant are being collected, after which the KTOP study will share more findings on what life is like for those those over 60 after receiving a transplant. A study day involving patients is planned, and this will help better understand the findings and how they can be used to improve care for older people waiting for and receiving a transplant.

The KTOP study is just the start, and the team are optimistic that the next steps will focus on bringing changes to all aspects of older people’s care, especially addressing patients priorities and supporting them better during this time.

Read more about Professor Edwina Brown’s work. 

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