Correlations, agreement and utility of frailty instruments in prevalent haemodialysis patients: baseline cohort data from the FITNESS study

Abstract

Background Frailty is associated with poor outcomes for haemodialysis patients, but its prevalence is uncertain due to heterogeneous definitions. The aim of this study was to compare and contrast prevalence and features of commonly used frailty instruments in an English haemodialysis cohort. Methods The FITNESS study recruited adults aged ≥18-years after informed consent, with ≥3-months haemodialysis exposure and no hospital admission within 4-weeks unless for dialysis access. Study participants were clinically phenotyped with frailty instruments including the Frailty Index (FI), Frailty Phenotype (FP), Edmonton Frailty Scale (EFS), and Clinical Frailty Scale (CFS), alongside comprehensive baseline data collection of biochemical, clinical and social characteristics. Results Between 12th January 2018 and 18th April 2019, 485 haemodialysis patients were recruited. Baseline demographics were median age 63 years, male sex 58.6% and non-White ethnicity 42.1%. Prevalence of frailty was high; 41.9% of participants were frail by FP, 63.3% by FI, 50.2% by EFS, and 53.8% by CFS. Female gender was associated with increased frailty, with no independent association observed with age or ethnicity. While correlation between frailty instruments was strong, intraclass correlation coefficient for frailty agreement was 0.628 (95% C.I. 0.585-0.669) and only weak agreement between instrument pairs. Conclusion Frailty is highly prevalent among haemodialysis patients regardless of criteria used. However, our data suggests caution when interpreting heterogenous definitions of frailty for haemodialysis patients as they are not inter-changeable. Consensus agreement on the optimal frailty definition for haemodialysis patients must balance ease of use with predictive ability for adverse outcomes before determining clinical application.

Evaluation of the impact of an intradialytic exercise programme on sarcopaenia in very elderly haemodialysis patients

“…Exercise improved physical frailty as measured by the Fried scale as well as the lower limb parameter of the STS-5. Lower limb frailty is related to adverse outcomes in HD patients [ 36 ]. A positive trend was also observed for the mean values for almost all components of the EWGSOP2 steps, which was evident both at the end of the programme and persisted 12 weeks after the end of the programme.…”

Ultrasound quadriceps muscle thickness is variably associated with frailty in haemodialysis recipients

“…The Clinical Frailty Scale (CFS) [ 8 ], is a brief frailty tool derived from and validated against the FI. Previous work within the FITNESS study has shown that correlation is weak and agreement minimal between these scores in haemodialysis recipients [ 9 ], but all are associated with greater mortality [ 10 ].…”

Healthy aging and chronic kidney disease

“…van Loon et al [14] compared various frailty screening tools, including the Fried Frailty Phenotype, Groningen Frailty Indicator, Geriatric 8, the Identification of Seniors at Risk and the Hospital Safety Program, where the sensitivity ranged from 48% (Fried Frailty Phenotype) to 88% (Geriatric 8). Anderson et al [38] compared the Frailty Index, Frailty Phenotype, Edmonton Frail Scale, and Clinical Frailty Scale in HD patients and found that agreement between different frailty tools was weak and the tools themselves were not interchangeable. The selection of an optimal frailty screening tool requires the balance between utility in decision-making, interventions or outcomes intended and ease of ad-ministration.…”