Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools.

Abstract

The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities were collected at baseline and at three months interval for one year. Functional performance was assessed using Karnofsky scale. The Charlson comorbidity index was used to assess comorbid status of each patient. Frailty was assessed using a combination of PRISMA questionnaire and Timed up and Go test. End points were death or start of dialysis at 20-month follow-up. A frail group (n = 58; males = 32, females = 26) and a nonfrail group (n = 46; males = 21, females = 25) were identified. Frailty was prevalent in 53.8% of the selected population. There was no significant difference between both groups in terms of age, gender, comorbidities, hemoglobin, inflammatory markers, or calcium hemostasis. Nine patients chose conservative management in the frail group and six in nonfrail group. Rate of death was significantly higher in the frail group (death = 14) compared to nonfrail group (death = 3; P = 0.01). There was no significant difference between both groups in terms of initiation of dialysis (P = 0.1). Frailty and Charlson comorbidity index were significantly associated with mortality (P = 0.023 and 0.032, respectively). Survival in frail patients who started peritoneal dialysis (PD) was slightly better than those started on hemodialysis (HD) with hazard ratio = 3.23 (P = 0.23). Our study shows that the prevalence of frailty and mortality rate is high among elderly predialysis patients. Frailty and Charlson comorbidity index are independent predictors of outcome in this population. PD might be a better option of dialysis modality compared to HD in the frail population.