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.

Comparison of geriatric assessment tools for frailty among community elderly

“…The community health volunteer recorded the total score. The male and female participants were considered in the frail group if the total score was ≥3 and in the non-frail group if the total score was equal to 0–2 [ 14 , 33 , 34 ].…”

Pre-Frailty and Frailty in Dialysis and Pre-Dialysis Patients: A Systematic Review of Clinical and Biochemical Markers

“…Samples size ranges varied from 61 to 605 participants. Three studies (60%) included in this systematic review have samples with more than 100 participants which can be considered significant, however, the studies are not consistent in sample size and there is a considerable gap between the 61-person sample [ 1 ] and the study with the biggest sample of 605 people [ 19 ]. Some of the studies ( n = 2, 40%) did not report on ethnicity.…”

“…All the studies included in this review can be broadly classified as observational, however, cohort studies were performed by most of the groups (n = 3, 60%) and crosssectional studies performed by the remaining two groups (40%). The follow-up period in the cohort study carried by one of the studies [19] was 1.1 years, in one other study [20] the population was followed up for 20 months, and 12 months was the follow-up time used by the third group [1]. Most of the studies (n = 4, 80%) recruited the population by convenience from the community, although one study [20] did not report the background of the population; contact with the author to obtain information was attempted but no answer was obtained.…”

Frailty phenotype and multi-domain impairments in older patients with chronic kidney disease

“…In previous studies performed in CKD populations prevalence of frailty ranged from 16 to 88% depending on the methods and the definitions that were adopted [7,[11][12][13][26][27][28][29]. This variability depends on the fact that the definitions used to identify frailty are pretty variegated and take in account different clinical and functional aspects.…”