Frailty Screening Tools for Elderly Patients Incident to Dialysis

Loon, Ismay N van; Goto, Namiko; Boereboom, F. T. J.; Bots, Michiel L.; Verhaar, Marianne C.; Hamaker, Marije E.

doi:10.2215/cjn.11801116

Cited by 80 publications

(61 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: Discussionmentioning

confidence: 70%

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Nixon

Bampouras

Pendleton

et al. 2018

Nephron

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 70%

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Nixon

Bampouras

Pendleton

et al. 2018

Nephron

View full text Add to dashboard Cite

show abstract

“…In our study population, 62 and 46% of the patients initiating dialysis were considered frail based on the GFI and Fried Frailty Index respectively. Although some frailty screening tools have a high sensitivity and positive predictive value for vulnerability as determined by a full GA, the negative predictive value is not higher than 60% [43]. Therefore, a negative frailty screening cannot be used in a clinical setting to direct treatment decisions, since many vulnerable patients will be missed.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Goto

Loon

Morpey

et al. 2018

Nephron

View full text Add to dashboard Cite

Background/Aims: Decision-making in elderly patients considering dialysis is highly complex. With the increasing number of elderly with end-stage kidney disease (ESKD), it may be important to assess geriatric impairments in this population. The aim of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study was to assess the prevalence of geriatric impairments and frailty in the elderly ESKD population by means of a geriatric assessment (GA), which is a comprehensive tool for overall health assessment. Methods: This study included 285 patients ≥65 years: 196 patients at the time of dialysis initiation and 89 patients who chose maximal conservative management (MCM). The GA assessed cognition, mood, nutritional status, (instrumental) activities of daily living (ADL), mobility, comorbidity burden, quality of life and overall frailty. Results: The mean age of the participants was 78 years and 36% were women. Of the incident dialysis patients, 77% started haemodialysis and 23% started peritoneal dialysis. Geriatric impairments were highly prevalent in both dialysis and MCM patients. Most frequently impaired geriatric domains in the dialysis group were functional performance (ADL 29%, instrumental ADL (iADL) 79%), cognition (67%) and comorbidity (41%). According to the GA, 77% in the dialysis group and 88% in the MCM group had 2 or more geriatric impairments. In the MCM group, functional impairment (ADL 45%, iADL 85%) was highly prevalent. Conclusions: Geriatric impairments are highly prevalent in the elderly ESKD population. Since impairments can be missed when not searched for in regular (pre)dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.

show abstract

“…While there are numerous approaches to identify if a person is frail, none have shown both high sensitivity and specificity in older dialysis patients when compared to CGA. 31 In an evaluation of 6 different screening approaches, the identification of seniors at risk (ISAR) instrument had both moderate sensitivity (72%) and specificity (79%); however, more than half (52%) of dialysis patients who are not frail by ISAR were still found to have 2 or more geriatric problems (eg, cognitive impairment, depression, mobility impairment, poor nutrition, or limitations in activities of daily living). 31 Although these alternatives may not perform as well as CGA for identifying geriatric problems, some providers apply them to screen for patients who would benefit from CGA.…”

Section: Comorbidity Disability and Low Physical Activitymentioning

confidence: 99%

Breaking the cycle of functional decline in older dialysis patients

Hall

McAdams‐DeMarco

2018

Seminars in Dialysis

View full text Add to dashboard Cite

Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home. Progressive functional decline may appear to be unavoidable for older dialysis patients; however, comprehensive geriatric assessment (CGA) may alleviate the prevalence and severity of functional decline. This editorial summarizes common risk factors of functional decline and introduces CGA as a potentially transformative approach to breaking the cycle of functional decline in older dialysis patients.

show abstract

Frailty Screening Tools for Elderly Patients Incident to Dialysis

Cited by 80 publications

References 47 publications

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Breaking the cycle of functional decline in older dialysis patients

Contact Info

Product

Resources

About