WTP2.2 Subjective Assessment of Frailty Compared to Validated Frailty Assessment in Adults with Chronic Renal Failure presenting for Dialysis-Access/Transplant workup has Poor Estimation of Agreement

Abstract

Abstract Purpose Frailty assessment often rely on subjective frailty assessment, such as ‘the end-of-the-bed’ or ‘eyeball’ test. These assessments have traditionally been accurate in 40% of cases only. Frailty assessment is a part of our institutional clinical workup. We examined the association between subjective frailty and formal validated score aided frailty estimation in the adult renal failure population. Methods A cohort of all renal failure patients presenting for dialysis access/transplant assessment at a satellite unit over one year (December 2020-2021) was analyzed. Adult patients aged ≥18 years in the outpatient dialysis access/transplant assessment surgical clinic were rated with eyeball test in routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment was examined. Results A total of 113 patients were approached, producing 109 paired frailty assessments. The median age of the patients was 62 years. The Composite Proportions of Agreement of clinician-estimated frailty to formal frailty was poor (0.57). The sensitivity of the Eyeball test was 0.30 & specificity was 0.43. The sensitivity of the Frailty Score was 0.70 & specificity was 0.57. The validated tool has more than twice the odds of estimating frailty OR 2.86 (1.49- 5.46). p=0.002 (2-tailed). Conclusion Subjective frailty assessment is not a reliable replacement for formal frailty assessment in adults with renal failure. The validated Frailty Tool provides a uniform frailty estimation.