Abstract
BackgroundThe Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. However, these 5 components may not fully capture physiologic reserve in this population. We aimed to ascertain opinions of ESRD clinicians and patients about the usefulness of the Fried frailty phenotype and interventions to improve frailty in ESRD patients, and to identify novel components to further characterize frailty in ESRD.MethodsClinicians who treat adults with ESRD completed a 2-round Delphi study (n = 41 and n = 36, respectively; response rate = 87%). ESRD patients completed a survey at transplant evaluation (n = 460; response rate = 81%). We compared clinician and patient opinions on the constituent components of frailty.ResultsClinicians were more likely than patients to say that ESRD makes patients frail (97.6% vs. 60.2%). There was consensus among clinicians that exhaustion, low physical activity, slow walking speed, and poor grip strength characterize frailty in ESRD patients; however, 29% of clinicians thought weight loss was not relevant. Patients were less likely than clinicians to say that the 5 Fried frailty components were relevant. Clinicians identified 10 new ESRD-specific potential components including falls (64%), physical decline (61%), and cognitive impairment (39%). Clinicians (83%) and patients (80%) agreed that intradialytic foot-peddlers might make ESRD patients less frail.ConclusionsThere was consensus among clinicians and moderate consensus among patients that frailty is more common in ESRD. Weight loss was not seen as relevant, but new components were identified. These findings are first steps in refining the frailty phenotype and identifying interventions to improve physiologic reserve specific to ESRD patients.
Highlights
The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components, is associated with poor outcomes among end stage renal disease (ESRD) patients
Because the Fried frailty phenotype was developed in communitydwelling older adults, some components may not be applicable to ESRD patients, and there may be aspects of physiologic reserve in ESRD patients that are not characterized by this phenotype
The primary goal of this study was to ascertain the opinions of experts who care for patients with ESRD and of ESRD patients pursuing kidney transplantation about the usefulness of the Fried frailty phenotype, and which novel components may further characterize frailty among ESRD patients
Summary
The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. These 5 components may not fully capture physiologic reserve in this population. Among end stage renal disease (ESRD) patients, the prevalence of the Fried frailty phenotype is 5 to 7-fold higher than in communitydwelling older adults [6] and is associated with higher mortality, more hospitalizations, more falls, poor cognitive function, and poor health-related quality of life [6,7,8,9]. Supporting this hypothesis, we have previously found that not all 5 components contribute to the value of the Fried phenotype in predicting mortality risk among KT recipients [16]
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