Frailty in end-stage renal disease: comparing patient, caregiver, and clinician perspectives

BMC Nephrology

Research Article

Heather C. Moffatt¹  Paige A. Moorhouse¹  Colin C. Turner²  Alison Dixon²  Bryce A. Kiberd³  David A. Clark³  Karthik K. Tennankore³  Usman Khan⁴  David Landry⁴ 

[1] Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada;Division of Internal Medicine, Dalhousie University, Halifax, NS, Canada;Division of Nephrology, Dalhousie University, 5070 Dickson Building, 5820 University Avenue, B3H 2Y9, Halifax, NS, Canada;Nova Scotia Health Authority, Halifax, NS, Canada;

关键词: Frailty;    Dialysis;    Fried phenotype;    Frailty index;    Clinical frailty scale;   

DOI  :  10.1186/s12882-017-0558-x

 received in 2016-10-18, accepted in 2017-04-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundFrailty is associated with poor outcomes for patients on dialysis and is traditionally measured using tools that assess physical impairment. Alternate measurement tools highlight cognitive and functional domains, requiring clinician, patient, and/or caregiver input. In this study, we compared frailty measures for incident dialysis patients that incorporate patient, clinician, and caregiver perspectives with an aim to contrast the measured prevalence of frailty using tools derived from different conceptual frameworks.MethodsA prospective cohort study of incident dialysis patients was conducted between February 2014 and June 2015. Frailty was assessed at dialysis onset using: 1) modified definition of Fried Phenotype (Dialysis Morbidity Mortality Study definition, DMMS); 2) Clinical Frailty Scale (CFS); 3) Frailty Assessment Care Planning Tool (provides CFS grading, FACT-CFS); and 4) Frailty Index (FI). Measures were compared via correlation and sensitivity/specificity analyses.ResultsA total of 98 patients participated (mean age of 61 ± 14 years). Participants were primarily Caucasian (91%), male (58%), and the majority started on hemodialysis (83%). The median score for both the CFS and FACT-CFS was 4 (interquartile range of 3–5). The mean FI score was 0.31 (standard deviation ± 0.16). The DMMS identified 78% of patients as frail. The FACT-CFS demonstrated highest correlation (r = 0.71) with the FI, while the DMMS was most sensitive (97%, 100%) and a CFS ≥ 5 most specific (100%, 77%) at corresponding FI cutoff values (>0.21, >0.45).ConclusionsFrailty assessments of incident dialysis patients that include clinician, caregiver and patient perspectives have moderate to strong correlation with the FI. At specified FI cutoff values, the FACT-CFS and DMMS are highly sensitive measures of frailty. The CFS and FACT-CFS may represent viable alternative screening tools in dialysis patients.

【 授权许可】

CC BY   
© The Author(s). 2017