Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: an observational study of feasibility and associations

Abstract

Background There is an unmet need for routine and accurate prognostication of older adults with end‐stage kidney disease (ESKD) and subsequently inadequate advance care planning. Frailty, a clinical syndrome of increased vulnerability, is predictive of adverse health outcomes in the renal population. We propose the Clinical Frailty Scale (CFS) as a feasible tool for routine use in the nephrology outpatient setting to address this unmet need. Aims To assess feasibility and associations of incorporating CFS assessment into routine outpatient nephrology practice in the pre‐dialysis setting. Methods CFS was integrated into the outpatient nephrology clinic proforma. A convenience sample of 138 patients aged >50 years, with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, attending the outpatient service between September 2018 and April 2019 was included. Results Eighty‐one CFS assessments were completed by nephrologists, nephrology advanced trainees and clinical nurse specialists. CFS completion rates were 79% from the multidisciplinary Low Clearance Clinic and 41% from nurse‐led Pre‐dialysis Education Clinic. Planned modality of ESKD management varied with degree of frailty (P < 0.001). 21% of patients who had CFS completed were planned for Conservative Management of ESKD, in contrast to only 5% of those who did not have CFS assessment completed (P < 0.001). Conclusion Frailty assessment via CFS was feasible in outpatient practice when integrated into routine clinical assessment in a dedicated clinic. Planned ESKD management varied with the degree of frailty. Completion of frailty assessment, when compared with non‐completion, appears to be associated with increased planned conservative management of ESKD.

Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease

“… 8 , 9 Clinical Frailty Scale (CFS) has been demonstrated to be a useful bedside tool for frailty assessment, allowing incorporation into routine clinical practice and assisting in key clinical decisions. 10 …”

“…8,9 Clinical Frailty Scale (CFS) has been demonstrated to be a useful bedside tool for frailty assessment, allowing incorporation into routine clinical practice and assisting in key clinical decisions. 10 Given the increased incidence of HF in CKD and the additional morbidity and mortality associated with it, understanding the characteristics of this cohort and identifying factors associated with key clinical outcomes is important. Fiona Stanley Hospital (FSH) is a leading centre in HF management with over 500 fracture presentations each year.…”

Frailty in chronic kidney disease: challenges in nephrology practice. A review of current literature

“…Both self-perceived and objective measures of frailty predict a not-for-dialysis maximum conservative management pathway. 27,28 Discrete choice experiments reveal that nephrologists were less likely to recommend dialysis for patients with impaired cognition, reduced life expectancy, poor current quality of life or increased comorbidity, reflecting a reluctance on both sides of a shared decision-making model to initiate dialysis in frail patients. 29 Indeed, observational cohort studies suggest the survival benefit of dialysis is lost in patients over 75 years with cardiovascular comorbidities.…”

Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease

“…Multiple frailty screening tools have been evaluated in CKD populations and perform reasonably well [28][29][30][31][32]. Notably, the widely cited Clinical Frailty Scale (CFS) [21,33], a global 9-point scale that guides the clinical judgement of an individual's frailty status, has been shown to be associated with adverse outcomes in Australian, Canadian, Japanese, South Korean, and UK CKD populations [34][35][36][37][38][39][40][41][42][43][44]. A limitation of the CFS is that it relies on a healthcare professional to make a subjective assessment, albeit an informed one.…”