Applicability of laboratory deficit‐based frailty index in predominantly older patients with end‐stage renal disease under chronic dialysis: A pilot test of its correlation with survival and self‐reported instruments

Abstract

Aim Laboratory deficit‐based frailty index (LFI) exhibited outcome‐prediction ability in the elderly, but not in those with end‐stage renal disease (ESRD). We hypothesized that LFI results might have outcome correlation and correlate closely with other instruments in ESRD patients. Methods We prospectively enroled ESRD patients between 2014 and 2015 and administered self‐report frailty instruments (Strawbridge questionnaire, Edmonton frail scale (EFS), Groningen frailty indicator (GFI), Tilburg frailty indicator, G8 questionnaire and FRAIL scale), and Cardiovascular Health Study (CHS) scale, with two types of LFI calculated. They were followed up until June 30, 2017. Correlations between the results of six instruments, CHS scale, and those of LFI were identified, followed by Kaplan–Meier survival analyses and logistic regression analyses to compare those with high and low LFI. Results The frailty prevalence was 33.3% (CHS), 78.8% Strawbridge questionnaire, 45.5% (EFS), 57.6% (GFI), 27.3% (Tilburg frailty indicator), 84.8% (G8) and 18.2% (FRAIL) among ESRD participants. LFI‐1 results were significantly correlated with those of LFI‐2 (P < 0.01), EFS (P = 0.04) and GFI (P < 0.01), while LFI‐2 results were not. Those with CHS or GFI‐identified frailty had significantly lower 1,25‐(OH)2‐D levels than those without. After 32.3 ± 5.4 months, patients with high LFI‐1 scores, but not LFI‐2, had a significantly higher mortality than those with lower scores. GFI and EFS scores were also independently associated with LFI‐1, while CHS scores exhibited borderline association only. Conclusion Among a group of predominantly older ESRD patients, LFI differentiates patients with good and poor outcomes, supporting its applicability in these patients.

Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults

“…However, none of the existing studies identify the association between aberrant RDW levels and the risk of frailty in older adults (7). The relationship between this hemogram component and frailty in older adults may be explained by several reasons; first, the RDW-frailty association may be reflective of the biologic importance of RDW similar to that of the laboratory frailty indices, which have been shown to be important outcome predictors (32,33). Second, a high RDW level, as a surrogate of hemogram abnormalities, may influence the possibility of having frailty through the relationship between aberrant RBC, leukocyte, or platelet indices and frailty (34)(35)(36).…”

The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults

“…25 The FI-LAB overcomes the need to ask questions, perform physical assessments, conduct CGA, or dependence on claims from EHR. The FI-LAB has shown good diagnostic accuracy and prediction of clinical outcomes in diverse groups including community-dwelling individuals, [26][27][28][29] endstage renal disease, 30 hospitalized, 31,32 and institutionalized. 26,33 Higher scores are associated with worse selfreported health, high utilization, 27,29 disability, 29 institutionalization, polypharmacy, falls, 27 and all-cause mortality.…”

“…26,33 Higher scores are associated with worse selfreported health, high utilization, 27,29 disability, 29 institutionalization, polypharmacy, falls, 27 and all-cause mortality. [26][27][28][29][30][31]33 Three observational studies evaluated the predictive performance of 23-item FI-LABs in hospitalized older adults. Two retrospective cohort studies investigating the association of FI-LAB upon admission and in-hospital mortality yielded mixed data.…”

Development of an Administrative Data-Based Frailty Index for Older Adults Receiving Dialysis

“…14 Few studies have explored a frailty index in the dialysis population. In one study using a laboratory based frailty index (LFI) (index with deficits determined from abnormal values for blood pressure, electrolytes, hemoglobin and other lab values), older adults receiving HD with a high LFI had lower survival rates than those with low LFI 23 . A separate study developed a transplant wait list-specific frailty index using medical record and survey responses among transplant candidates 24 .…”