#5397 FRAILTY ASSESSMENT TOOLS, SURVIVAL TIME AND TIME TO INITIATE DIALYSIS IN OLDER PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE

Abstract

Abstract Background and Aims Chronic Kidney Disease (CKD) patients with frailty have been shown to have a shorter survival time compared to non-frail individuals. Additionally, frailty has been linked to earlier initiation of dialysis among CKD patients. Despite the availability of over 50 frailty assessment tools in the literature, few have been applied in studies of older adults with CKD. There is a need for a comprehensive analysis of different frailty tools to identify the most accurate tools that could predict survival time and time to start dialysis in older adults with CKD. The present study compares four commonly used assessment tools of frailty from different categories (self-reporting tools, clinical judgment tools and complex instruments) regarding their association with survival time and time to start dialysis. Method Two hundred forty patients with biochemical evidence of CKD Stages 4–5 were included in this prospective cohort study. The inclusion criteria included patients 65 years old or more with two consecutive measurements of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 separated by more than three months, while exclusion criteria included dialysis dependence, history of kidney transplantation, recent acute kidney injury, initial visit with the provider, amputation, or cerebrovascular accident. The four frailty assessment tools used in the study were Prisma-7 and FRAIL Scale, Clinical Frailty Scale (CFS), and Frailty Phenotype (FP). Patients were followed-up for 36 months for death events or dialysis initiation. Results The study population (240 patients) comprised 46% male patients with a mean age of 73.8 ± 6.6 years. Approximately 25% of patients were considered frail using the FRAIL scale, 69% using Prisma-7, and almost 40% using CFS and FP. Except for Prisma-7, “frail” patients, as determined by the FRAIL, CFS, and FP scores (Fig. 1), had significantly shorter survival times, with a mean survival of 24.9 months (Log-rank p <0.001), 27.3 months (Log-rank p = 0.041), and 26.6 months (Log-rank p = 0.004) respectively. No significant differences were observed in time to dialysis initiation when comparing frail and non-frail patients using any of the frailty assessment tools (Table 1). Conclusion The findings suggest that the frailty scores derived from the FRAIL, CFS, and FP tools are better predictors of survival time in frail elderly patients with CKD, while further research is required to determine the most appropriate frailty tool to predict the time to start dialysis in this population.