Frailty and chronic kidney disease: A systematic review

Chowdhury, Rakin; Peel, Nancye M.; Krosch, Mitchell; Hubbard, Ruth E.

doi:10.1016/j.archger.2016.10.007

Cited by 299 publications

(294 citation statements)

References 48 publications

(76 reference statements)

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“…To our knowledge, although frailty screening methods have been evaluated in CKD populations, this is the first study that evaluates the diagnostic accuracy of the Clinical Frailty Scale, PRISMA-7 and FI-LAB in a pre-dialysis and dialysis dependent CKD population using the Frailty Phenotype as the reference standard [3,[34][35][36][37]. Comparable to other reports, the prevalence of frailty increased with worsening kidney function in this cohort [5,38,39].…”

Section: Discussionsupporting

confidence: 52%

“…Many of the pathophysiological processes inherent to chronic kidney disease (CKD) appear to propagate the trajectory from robustness to frailty [2]. The prevalence of frailty increases with worsening kidney function, with a report categorising as many as two-thirds of dialysis-dependent CKD patients as frail [3,4]. Importantly, frail patients with CKD have worse outcomes than those that are robust with CKD, including an increased falls, hospitalisation and mortality rate [3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…The 2 most popular concepts are the Fried Frailty Phenotype and the deficit accumulation model, also known as the Frailty Index (FI) [14,15]. Though both have their individual merits, the Frailty Phenotype has a more robust evidence base in terms of predicting outcomes in CKD cohorts [3]. The Frailty Phenotype is a time-consuming evaluation involving a combination of questionnaires and physical assessments (online suppl.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Nixon

Bampouras

Pendleton

et al. 2018

Nephron

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Background/Aims: Frail patients with chronic kidney disease (CKD) have an increased hospitalisation and mortality rate. However, many popular frailty screening methods have not been validated in patients with CKD. This study evaluates the diagnostic accuracy of several frailty screening methods in patients with CKD G4–5 and those established on haemodialysis (G5D). Methods: Ninety participants with CKD G4–5D were recruited from Nephrology Outpatient Clinics and 2 Haemodialysis Units between December 2016 and December 2017. Frailty was diagnosed using the Fried Frailty Phenotype. The following frailty screening tests were evaluated: Clinical Frailty Scale, PRISMA-7, CKD Frailty Index, CKD FI-LAB, walking speed, hand grip strength and Short Physical Performance Battery. Results: The mean age of participants was 69 years (SD ±13). One-third of participants were dialysis-dependent. Nineteen (21%) patients were categorised as frail, 42 (47%) as pre-frail and 29 (32%) as robust. Overall, walking speed was the most discriminative measure (AUC 0.97 [95% CI 0.93–1.00], sensitivity 0.84 [95% CI 0.62–0.94], specificity 0.96 [95% CI 0.88–0.99]). The Clinical Frailty Scale had the best performance of the non-physical assessment frailty screening methods (AUC 0.90 [95% CI 0.84–0.97], sensitivity 0.79 [95% CI 0.57–0.91], specificity 0.87 [95% CI 0.78–0.93]). Conclusions: Walking speed can be used to accurately screen for frailty in CKD populations. If it is not practical to perform a physical assessment to screen for frailty, the Clinical Frailty Scale is a useful alternative.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Nixon

Bampouras

Pendleton

et al. 2018

Nephron

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“…The other potential factor that influencing on poor prognosis was frailty. Patients with CKD and CVD are more likely to be frail [22] because these are likely to exist in combination with comorbid conditions, disability, and polypharmacy [23,24]. In addition, frailty is also one of the important parameters of cancers [25,26].…”

Section: Risk-score-based Protocol Months After Rcmentioning

confidence: 99%

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Hatakeyama

Kusaka

Hosogoe

et al. 2018

JCO

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Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost effectiveness after radical cystectomy.Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal-and high-risk patients, but the medical expense was high, especially in normal-risk (≤pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol.Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-and high-risk groups by a pathologybased protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared.Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.

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“…Box 2.1 captures the main concepts in definitions of frailty. Frailty can be physical or psychological or a combination of the two, with two common models used to explain it: (1) frailty is seen as a syndrome where sarcopenia (loss of muscle with ageing) is the main underlying concept [8] and individuals have at least three of a list of features including; unintentional weight loss, exhaustion, weakness, slowness and reduced physical activity and (2) frailty as the sum of an individual's deficits and non-specific disorders [9] that prevent individuals from launching an effective response to health stressors, leading to adverse health outcomes [6,10].…”

Section: Frailtymentioning

confidence: 99%

Frailty, Sarcopenia and Falls

Marques

Queirós

2018

Perspectives in Nursing Management and Care for Older Adults

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Research confirms that frailty, sarcopenia and falls are strongly correlated [1] and both are predictors of negative health outcomes such as falls, disability, hospitalisation and death [2]. Interventions are necessary to reverse frailty and treat sarcopenia [3] as it has been estimated that, by the year 2025, around 20% of the population in industrial countries will be aged 65 years and over. As the number of older people increases, their needs will become an increasingly important health issue. Reduction in physical function can lead to loss of independence, need for hospital and longterm nursing home care and premature death. The importance of physical, functional, psychological and social factors in realising a healthy old age is recognised by older people, health-care professionals, policy advisors and decision-makers. This chapter will review the concepts of frailty, sarcopenia and falls as well as the interventions for older people, carried out by nurses and other health-care professionals, that have the potential to positively affect health and functional status and may promote independent functioning of older people with frailty and sarcopenia. Learning OutcomesAt the end of the chapter, and following further study, the nurse will be able to:

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Frailty and chronic kidney disease: A systematic review

Abstract: Frailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes. There are differences in the methods used to assess frailty and this hinders comparisons between studies.

Cited by 299 publications

References 48 publications

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Frailty, Sarcopenia and Falls

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