A Multicenter Home-based Prehabilitation Intervention in Kidney Transplant Candidates

Abstract

Background. Frailty is a modifiable risk factor for morbidity and mortality among kidney transplant (KT) candidates. We previously demonstrated that an 8-wk center-based exercise intervention is associated with improved frailty parameters in patients with advanced chronic kidney disease. This study aimed to adapt the intervention for home-based delivery and examine its feasibility, safety, and acceptability in a multicenter cohort of KT candidates. Methods. We conducted a prospective pilot study between January 2021 and November 2023 involving KT candidates from Mayo Clinic in Minnesota and Baylor St. Luke’s Medical Center in Texas. Adults approved for KT who were (1) frail or prefrail by the Physical Frailty Phenotype and/or (2) had a Short Physical Performance Battery score ≤10 were enrolled. The exercise intervention consisted of an individualized exercise prescription provided by a Mayo Clinic exercise physiologist followed by 8 weekly phone calls. Feasibility was assessed via retention rates, adverse events were recorded, and acceptability was assessed via survey. Results. Baseline characteristics of the 15 enrolled participants included a median age of 64 y, 73.3% were men, and 73.3% were of White race. Sixty percent of participants completed the intervention. No unanticipated adverse events occurred. Most participants strongly agreed that the exercise intervention was beneficial to their overall health. Conclusions. This pilot study demonstrates that a home-based 8-wk exercise intervention is a promising prehabilitation strategy in KT candidates and provides important preliminary data for future larger, randomized studies.