*Purpose: Frailty and lower extremity impairment, both indicators of poor physical performance, are predictive of all-cause mortality among patients awaiting kidney transplantation (KT). Diabetes, the most common cause of end-stage renal disease in the U.S., is a risk factor for both lower extremity impairment and frailty. The objective of our study was to evaluate the prevalence of, and risk factors for, lower extremity impairment and frailty among diabetic adults awaiting KT.

*Methods: We evaluated lower extremity function (using the Short Physical Performance Battery [SPPB]) and frailty (using the Fried frailty phenotype) in 272 adults approved for KT at our center between 12/2014 and 11/2016. Included participants were either ≥ 60 years old, diabetic or had a history of ≥ 3 years dialysis. The SPPB is a composite measure of balance, gait speed and chair stand time; a score ≤ 10 was defined as lower extremity impairment. Elevated hemoglobin A1c (HbA1c) and low serum albumin were defined as levels ≥ 8.0% and < 3.5 g/dL, respectively.

*Results: Our study cohort had a mean age of 62 ± 9 years, 62% were men, 80% were Caucasian, 59% had diabetes and 57% were on dialysis. Diabetes and low serum albumin were significantly associated with lower extremity impairment but not with frailty (graphic_). Among patients with diabetes, clinical risk factors independently associated with lower extremity impairment included female gender, peripheral neuropathy, prior stroke, peripheral vascular disease and low serum albumin. In contrast, the only clinical risk factor significantly associated with frailty on multivariate analysis was female gender. No relationship between age, body mass index, Caucasian race, history of dialysis or elevated HbA1c with either lower extremity impairment or frailty was observed.

*Conclusions: In a cohort of high-risk KT candidates, diabetes and low serum albumin were associated with a greater prevalence of lower extremity impairment than frailty. Among diabetics, clinical risk factors for lower extremity impairment and frailty differed. Further studies are needed to determine whether nutrition and exercise interventions can improve physical performance, and ultimately health outcomes and survival, in KT candidates with diabetes.

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