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Background <p>With prolonged waiting times for deceased-donor kidney transplantation (DDKT) in Japan, objective data on frailty among wait-listed patients are limited. We assessed frailty using body composition and nutritional measures to identify predictors of 1&#xa0;year mortality or hospitalization.</p> Methods <p>We retrospectively analyzed 134 patients on the DDKT waiting list starting December 2023. Body composition was assessed using multifrequency bioelectrical impedance analysis. Nutritional indices, including Survival Index, Prognostic Nutritional Index, Geriatric Nutritional Risk Index, and Nutrition Risk Index for Japanese Hemodialysis Patients, were calculated. Handgrip strength was also measured. Death or hospitalization within 1&#xa0;year was defined as an event. Random forest and SHapley Additive Explanation analyses were used to identify predictors of event occurrence.</p> Results <p>Among 134 patients (median age 58&#xa0;years, 68% male), 40% had obesity, 24% had sarcopenia, and nearly 50% exhibited malnutrition. The median dialysis duration was 10&#xa0;years. During 1&#xa0;year, 34 events (25%) occurred: seven deaths and 27 hospitalizations secondary to infection, malignancy, or heart failure. The fat mass index/fat-free mass index (FMI/FFMI) ratio was the strongest event predictor, followed by low grip strength, reduced SMI, low Survival Index, and low phase angle. Age, comorbidity index, and several nutritional indices showed limited predictive contributions.</p> Conclusions <p>A significant number of Japanese DDKT candidates demonstrated frailty characterized by obesity, sarcopenia, and malnutrition. Objective indicators, particularly FMI/FFMI, may aid in evaluating vulnerability and eligibility during registration and renewal. Integrating these measures into standardized national criteria may improve equity and outcomes in DDKT candidate selection.</p>

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Vulnerability and short clinical outcomes in patients on the deceased-donor kidney transplant waiting list

  • 期刊论文

  • 发表日期：

    2026年2月18日

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  • Shunta Hori,
  • Mitsuru Tomizawa,
  • Kuniaki Inoue,
  • Tatsuo Yoneda,
  • Akira Tachibana,
  • Yuki Oda,
  • Kenta Onishi,
  • Yosuke Morizawa,
  • Daisuke Gotoh,
  • Yasushi Nakai,
  • Makito Miyake,
  • Nobumichi Tanaka,
  • Kiyohide Fujimoto

摘要

Background

With prolonged waiting times for deceased-donor kidney transplantation (DDKT) in Japan, objective data on frailty among wait-listed patients are limited. We assessed frailty using body composition and nutritional measures to identify predictors of 1 year mortality or hospitalization.

Methods

We retrospectively analyzed 134 patients on the DDKT waiting list starting December 2023. Body composition was assessed using multifrequency bioelectrical impedance analysis. Nutritional indices, including Survival Index, Prognostic Nutritional Index, Geriatric Nutritional Risk Index, and Nutrition Risk Index for Japanese Hemodialysis Patients, were calculated. Handgrip strength was also measured. Death or hospitalization within 1 year was defined as an event. Random forest and SHapley Additive Explanation analyses were used to identify predictors of event occurrence.

Results

Among 134 patients (median age 58 years, 68% male), 40% had obesity, 24% had sarcopenia, and nearly 50% exhibited malnutrition. The median dialysis duration was 10 years. During 1 year, 34 events (25%) occurred: seven deaths and 27 hospitalizations secondary to infection, malignancy, or heart failure. The fat mass index/fat-free mass index (FMI/FFMI) ratio was the strongest event predictor, followed by low grip strength, reduced SMI, low Survival Index, and low phase angle. Age, comorbidity index, and several nutritional indices showed limited predictive contributions.

Conclusions

A significant number of Japanese DDKT candidates demonstrated frailty characterized by obesity, sarcopenia, and malnutrition. Objective indicators, particularly FMI/FFMI, may aid in evaluating vulnerability and eligibility during registration and renewal. Integrating these measures into standardized national criteria may improve equity and outcomes in DDKT candidate selection.