Feasibility and construct validity of a <scp>F</scp>railty index for patients with chronic kidney disease

Hubbard, Ruth E.; Peel, Nancye M.; Smith, Morgan; Dawson, Blake; Lambat, Zahed; Bak, Melissa; Best, Jennifer L.; Johnson, David W.

doi:10.1111/ajag.12231

Cited by 45 publications

(53 citation statements)

References 19 publications

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“…Although the idea and approach are relatively simple, the results yielded by the FI have been consistent across many settings, even though not every FI considers the same deficits, or even the same number of deficits 10, 18, 19. The prognostic implications of FI have been demonstrated not only in a variety of different chronic conditions (osteoporosis,20 human immunodeficiency virus and AIDS,21 kidney disease22) but also in acute disease states (trauma23). …”

Section: Discussionmentioning

confidence: 94%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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Section: Discussionmentioning

confidence: 94%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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“…However, the correlation between measuring grip strength and slowness versus estimating physical function using the SF-36 questionnaire is poor (r=-0.34 for gait speed; r=0.14 for grip strength) (59). There were eight studies that modified the Fried phenotype and used the approach of using questionnaire data to replace the measured variables (17,19,31,36,39,45,46,58). Subsequently, Painter et al conducted a comparison of measuring gait speed and grip strength versus questionnaire data in quantifying the prevalence of frailty in haemodialysis patients (19).…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, an abbreviated version of the FI with 58 variables has been applied to an outpatient setting of patients with CKD in a prior feasibility study (21). This took on average 10 minutes to complete and showed good internal validity when compared with the Fried Approach.…”

Section: Frailty Assessmentmentioning

confidence: 99%

“…FI was not directly compared with the Fried approach to classification of frailty. The previous pilot study did demonstrate that FI correlated with a modified Fried phenotype (p<0.001) (39). The goals of the FI-CKD study were to investigate how FI changes with severity of kidney function and dialysis status and not to prove its diagnostic superiority over the Fried phenotype.…”

Section: Limitations Of the Fi-ckd Studymentioning

confidence: 99%

“…Amongst the predialysis population the prevalence of frailty ranged from 7%, in a study of community dwellers with CKD (median estimated glomerular filtration rate (eGFR) = 49mLs/min), to 42.6% in a smaller study of patients with more severe CKD (mean eGFR = 27mLs/min). 20,21 A study by Rodriguez et al 22 had no patients who were frail, despite the sample population having severe CKD (mean eGFR =16). However, patients in this study were referred into the clinic for consideration for dialysis; as a consequence of this screening process, only those who were 'fit' were selected.…”

Section: Prevalence Of Frailtymentioning

confidence: 99%

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Frailty in chronic kidney disease

Chowdhury¹

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Frailty is regarded as the most problematic consequence of aging. Whilst there is no precise definition for frailty, most clinicians agree that patients who are frail are vulnerable to poor health.Frailty can be conceptualised as a syndrome with a set of symptoms and signs that are measured to give a categorical classification of frailty as described by Fried and colleagues. Alternatively, frailty can be considered as a state, where deficits in health across multiple organ systems accumulate over time. These deficits are summated to give a continuous measure of frailty called the frailty index (FI).Patients with chronic kidney disease (CKD) are at risk of frailty. CKD has effects in multiple systems and it leads to accelerated manifestation of frailty, especially in those who are on dialysis.The Fried approach to frailty assessment has been applied in numerous settings of patients with CKD. However, there are limitations of the Fried approach especially when the prevalence of frailty is high, and a more precise measure is needed of the severity of frailty in an individual.The thesis begins with a systematic review of frailty in patients with CKD. It focuses on how frailty is assessed, including the Fried approach and other assessment methods; differences in frailty between dialysis and pre-dialysis patients; and how frailty changes across the spectrum of severity in kidney function. The systematic review yielded 37 articles encompassing 53,000 patients with CKD. The most common method of frailty assessment was the Fried approach (n=27 articles, 73%).The prevalence of frailty ranged between 7% in a population of pre-dialysis patients with CKD to 73% in patients on dialysis. There was considerable heterogeneity in how the studies defined the Fried phenotype and this impacted on the reported prevalence of frailty. Regardless of the method of assessment, frailty was associated with an increased risk of mortality and hospitalization.The systematic review highlighted gaps in the current evidence, especially in better delineating risk amongst patients on dialysis where the prevalence of frailty may be high. This leads to the next chapter of the thesis, a prospective study of the Frailty Index in CKD (FI-CKD). The aim of the study was to investigate the frailty index (FI) in outpatients with pre-dialysis and dialysis dependent CKD. Associations between FI and kidney function were explored as well as the relationship between FI and change in kidney function, mortality and hospitalization after twelve months of follow up. Amongst 314 patients, the mean FI was 0.29 (SD 0.13) corresponding to a clinical description of mild to moderate frailty. FI was associated with an increased risk of mortality (OR:1.8; 95% CI 1.77 -2.44) and hospitalization (OR 1.3 95% CI 1.06-1.5). Patients with a higher CKD stage were significantly more likely to have a higher FI. However, there was no significant 2 differences in the average FI between dialysis and pre-dialysis patients, perhaps due to the limited number of patients on dialysi...

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Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus

Legge

Kirkland

Rockwood

et al. 2019

Arthritis & Rheumatology

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Objective To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). Methods For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health‐related quality of life (Short‐Form 36 [SF‐36] scores) were assessed. The SLICC‐FI was constructed using baseline data. The SLICC‐FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC‐FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC‐FI values and mortality risk, adjusting for demographic and clinical factors. Results In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC‐FI score was 0.17 ± 0.08 (range 0–0.51). Baseline SLICC‐FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC‐FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35–1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. Conclusion The SLICC‐FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC‐FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.

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Feasibility and construct validity of a Frailty index for patients with chronic kidney disease

Abstract: The FI-CKD is feasible in the outpatient setting and has good construct validity. The greater granularity of a continuous measure has the potential to inform decision-making regarding appropriate interventions for patients at the 'frail' end of the health spectrum.

Cited by 45 publications

References 19 publications

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Frailty in chronic kidney disease

Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus

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