Background: Clinical assessments of patient health status are integral in kidney transplant (KT) waiting list management. Few data exist on the whether the accuracy of clinical assessments of physical and cognitive function differ by patient age, sex, or race.

Methods: We enrolled adult KT candidates (age> 18 years) at a single center between January 1, 2016 and December 31, 2016 in a prospective cohort study. The participants' physicians rated their physical and cognitive function by clinical assessment. Participants were then tested for physical function with grip strength (kilograms [kg]) and gait speed (meters/second [m/s]), and cognitive function with the Montreal Cognitive Assessment (MOCA). Scores in the lowest quartile of each test were categorized as poor performance. We fit multivariable logistic regression models to compare physician discriminative accuracy for poor performance among older (age>65 years) versus younger, female versus male, and black versus non-black KT candidates.

Results: Among 300 KT candidates, 83 (28%) were >65 years old, 66% were black, and 63% were male. Poor cognitive performance was categorized as MOCA<19, slow gait speed as <0.6 m/s, and weak grip strength as <18 kg for females and <26 kg for males. In sex and race-adjusted models, discriminatory accuracy was similar in identifying older and younger candidates with poor cognition (C-statistic 0.49 vs 0.63, p=0.16), weak grip strength (0.68 vs 0.57, p=0.18), and slow gait speed (0.69 vs 0.75, p=0.45). In age and race-adjusted models, accuracy was similar among females and males for poor cognition (0.59 vs 0.66, p=0.43), weak grip strength (0.68 vs 0.68, p=0.85) and slow gait speed (0.76 vs 0.73, p=0.67). In age and sex-adjusted models, accuracy was lower among black versus non-black candidates for poor cognition (0.57 vs 0.74, p=0.03), and similar for weak grip strength (0.65 vs 0.71, p=0.51) and slow gait speed (0.74 vs 0.73, p=0.90).

Conclusion: Physician accuracy in identifying poor cognitive function was lower for black compared to non-black KT candidates. Accuracy of functional ratings ranged widely overall, and did not differ by age, race, or sex for physical function. Strategies are needed to improve the identification of functional impairments among KT candidates.

CITATION INFORMATION: Harhay M., Ranganna K., Levin Mizrahi L., Xiao G., Malat G., Reich D., Guy S., Reese P. Discriminative Accuracy of Physician Assessments of Kidney Transplant Candidate Function by Candidate Age, Sex, and Race Am J Transplant. 2017;17 (suppl 3).

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