Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

Abstract

BackgroundThe incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education.MethodsWe performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015.ResultsThe CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death.ConclusionA relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease.

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

“…Alfaadhel et al [49] demonstrated that each point increase in the Clinical Frailty Scale score at dialysis initiation was associated with a mortality hazard ratio of 1.22 (95% CI 1.04-1.43). Pugh et al [50] also showed an association with Clinical Frailty Scale scores and mortality in a group of CKD patients referred for pre-dialysis education (hazard ratio 1.35 [95% CI 1.16-1.57]). Finally, Iyasere et al [48] demonstrated that higher Clinical Frailty Scale scores are associated with worse health-related quality of life in older patients receiving assisted peritoneal dialysis and haemodialysis.…”

“…The Clinical Frailty Scale had the best performance of these measures in terms of identifying frailty. It also has the most extensive evidence base for predicting outcomes in patients with CKD [15,[48][49][50]. Alfaadhel et al [49] demonstrated that each point increase in the Clinical Frailty Scale score at dialysis initiation was associated with a mortality hazard ratio of 1.22 (95% CI 1.04-1.43).…”

“…If it is not practical to perform a physical assessment, a non-physical assessment frailty screening method should be performed. The Clinical Frailty Scale was the most accurate non-physical assessment frailty screening method and currently has the strongest evidence base for prognostication in advanced CKD populations [48][49][50]. Further study is needed on the optimum management strategies for frail patients with CKD.…”

Incorporating the Clinical Frailty Scale Into Routine Outpatient Nephrology Practice: An Observational Study of Feasibility and Associations

“…However, currently there is an unmet need for routine and accurate prognostication of older adults with End Stage Kidney Disease (ESKD) (3). Frailty, a clinical syndrome of increased vulnerability, is predictive of adverse health outcomes in the renal population (4). We propose the Clinical Frailty Scale (CFS) as a feasible tool for routine use in the nephrology outpatient setting.…”

Dialysis: Survival and Palliation

“…[14].Individuals who had a shorter survival on dialysis are older, with evidence of systemic inflammation (low albumin), had comorbid illnesses, reduced. Many were probably frail prior to dialysis which would predict reduced appetite, sarcopenia, dysgeusia, increased falls, cognitive impairment and mortality [15,16]. Another recent study found that a simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease [17].…”