The Kidney Foundation of Canada

Dr. Karthik Tennanhore 

Dr. Karthik Tennanhore

Nova Scotia Health Authority, Nova Scotia
Co-Applicant(s):  Ian Alwayn, Marc Dorval, Nessa Gogan, Tammy Keough-Ryan, Bryce Kiberd, Sean Martin, Amanda Miller, Kenneth Rockwood, Laura Sills, Kenneth West, Seychelle Yohanna

Frailty and the kidney transplant wait list


2017-2019:  $100,000  |  Biomedical Research Grants  |  Category: Transplantation

Biography

Dr. Karthik Tennankore received his MD at the University of Western Ontario and completed Internal Medicine and Nephrology at Dalhousie University. He went on to complete a two-year clinical fellowship in home dialysis at the Toronto General Hospital (University of Toronto) and concurrently obtained a Master’s Degree in Clinical Epidemiology through Harvard University.

He joined the Dalhousie Division of Nephrology in 2013. His clinical expertise includes in-center and home dialysis. From a research perspective, he is interested in studying and improving outcomes of patients after initiation of dialysis and transplantation, and in studying the effect of frailty on dialysis and transplant patient outcomes. He is involved in clinical trials and conducts a number of prospective cohort studies in nephrology.

Lay Summary

Every year, a growing number of Canadians are waiting for a kidney transplant who will not receive one because of the short supply of available kidneys. It is important to ensure that individuals who are on the kidney transplant waiting list are able to benefit from a transplant and that the process of deciding who is eligible is fair and objective.

Many people with advanced kidney disease will benefit from a kidney transplant. However, some people are not eligible because they have health conditions that would make the transplant surgery too risky, or would put them at a high risk of poor health after transplant. Deciding who is able to receive a transplant involves a detailed evaluation of a person’s health and a review by kidney transplant specialists who are knowledgeable about the risks.

Some people with kidney disease who are being considered for a kidney transplant have difficulties in many areas of their health that put them at a risk for a shortened lifespan. This is often referred to as frailty. Being “frail” may affect how people walk (for example using walking aids or supports), their level of function (for example trouble with doing daily activities like dressing or bathing), their fitness, and their activity. We know that being frail may lead to negative health consequences after receiving a kidney transplant. However, we do not know how being frail might affect people who are waiting for a kidney transplant, because assessing their function, fitness, and activity is not a standard part of the evaluation. Knowing this information could be helpful for individuals and kidney transplant specialists in a number of ways. If individuals who are frail are at a much higher risk of death, being removed from the waitlist or dying soon after transplant, it may become a new tool that transplant specialists use to determine eligibility for the list. This tool would then allow transplant specialists to make objective decisions about eligibility, and not rely only on their clinical impression. It may help the kidney transplant team to identify individuals that have been accepted to the kidney transplant wait list that might need closer monitoring. Finally, it might provide a more complete picture of a person’s overall health that complements the tests that are currently used, and this information could be used to better inform patients who are inquiring about being put on the kidney transplant waitlist. 

In this study, we aim to examine what happens to people who are frail and being waitlisted for a kidney transplant. This study will include individuals with kidney disease from several centers across Canada in the provinces of Nova Scotia, New Brunswick, Newfoundland, and Ontario. We will use three different tools to assess frailty. We will then follow individuals closely to see if they experience a decline in health and are removed from the waitlist or die before they can receive a transplant. We will also follow those individuals who are eventually transplanted to see if they die or lose function of their transplanted kidney in a short time.

Finally, we will also see how frailty status changes for those who are waiting for a transplant. We hope that the findings will contribute to the practice of transplantation across Canada and perhaps worldwide. In the future, we hope that this study will be the first step to a National, standardized evaluation of a patient’s function, fitness, and activity when being considered for a kidney transplant.

The Kidney Foundation strives to better support people affected by kidney disease, and a key element of this is timely access to kidney transplantation and care for patients who are waiting for a transplant. Knowing how frailty impacts someone’s health may lead to better allocation of this important, limited resource.