Abstract
BackgroundFrailty is associated with poor outcomes for patients on dialysis and is traditionally measured using tools that assess physical impairment. Alternate measurement tools highlight cognitive and functional domains, requiring clinician, patient, and/or caregiver input. In this study, we compared frailty measures for incident dialysis patients that incorporate patient, clinician, and caregiver perspectives with an aim to contrast the measured prevalence of frailty using tools derived from different conceptual frameworks.MethodsA prospective cohort study of incident dialysis patients was conducted between February 2014 and June 2015. Frailty was assessed at dialysis onset using: 1) modified definition of Fried Phenotype (Dialysis Morbidity Mortality Study definition, DMMS); 2) Clinical Frailty Scale (CFS); 3) Frailty Assessment Care Planning Tool (provides CFS grading, FACT-CFS); and 4) Frailty Index (FI). Measures were compared via correlation and sensitivity/specificity analyses.ResultsA total of 98 patients participated (mean age of 61 ± 14 years). Participants were primarily Caucasian (91%), male (58%), and the majority started on hemodialysis (83%). The median score for both the CFS and FACT-CFS was 4 (interquartile range of 3–5). The mean FI score was 0.31 (standard deviation ± 0.16). The DMMS identified 78% of patients as frail. The FACT-CFS demonstrated highest correlation (r = 0.71) with the FI, while the DMMS was most sensitive (97%, 100%) and a CFS ≥ 5 most specific (100%, 77%) at corresponding FI cutoff values (>0.21, >0.45).ConclusionsFrailty assessments of incident dialysis patients that include clinician, caregiver and patient perspectives have moderate to strong correlation with the FI. At specified FI cutoff values, the FACT-CFS and DMMS are highly sensitive measures of frailty. The CFS and FACT-CFS may represent viable alternative screening tools in dialysis patients.
Highlights
Frailty is associated with poor outcomes for patients on dialysis and is traditionally measured using tools that assess physical impairment
Frailty is mostly operationalized by the Frailty Index or the Fried Phenotype [8], each of which is derived from different conceptual frameworks [1, 2, 9]
In pre-specified sensitivity analyses, we evaluated sensitivity/specificity of the Clinical Frailty Scale (CFS), Frailty assessment care planning tool (FACT)-CFS, and Dialysis Morbidity and Mortality Study (DMMS)-Frail compared with the Frailty Index as the reference standard
Summary
Frailty is associated with poor outcomes for patients on dialysis and is traditionally measured using tools that assess physical impairment. We compared frailty measures for incident dialysis patients that incorporate patient, clinician, and caregiver perspectives with an aim to contrast the measured prevalence of frailty using tools derived from different conceptual frameworks. Frailty is mostly operationalized by the Frailty Index or the Fried Phenotype [8], each of which is derived from different conceptual frameworks [1, 2, 9]. Clark et al BMC Nephrology (2017) 18:148 individual patient (according to specific criteria) regardless of the domain or type of deficit involved [2]. While valuable, both methods can be cumbersome, lending difficulty to practical implementation in a clinical setting. The Frailty Index, while highly precise on a population level, is difficult to apply to individual decision making discussions [11]
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