Frailty Intervention Trial iN End-Stage patientS on haemodialysis (FITNESS): study protocol for a randomised controlled trial

Anderson, Ben; Dutton, Mary Ann; Day, Ed; Jackson, Thomas; Ferro, Charles J.; Sharif, Adnan

doi:10.1186/s13063-018-2842-x

Cited by 17 publications

(19 citation statements)

References 47 publications

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“…Our study appears to be the first to demonstrate the effect of frailty on adherence to recommendations in hemodialysis patients, also of younger age. Depending on assessment method, several authors reported frailty was three- to tenfold more common in hemodialysis patients compared to older subjects with normal renal function [5,17,22,51,52]. Since low physical activity is a criterion in frailty definition [53], interventions leading to increased physical activity might reduce or reverse frailty status, both directly and indirectly, provided they improve physical fitness or reduce the symptoms of fatigue and exhaustion [54].…”

Section: Discussionmentioning

confidence: 99%

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Hornik

Duława

2019

IJERPH

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Hemodialysis patients perform little physical activity. We formulated a hypothesis that some factors, i.e., frailty, medical and functional factors, psychological factors, quality of life, awareness of recommendations, and sociodemographic factors influence the decisions of taking up physical activity. This prospective study comprised 72 dialysis patients aged 57.8 ± 16.0 ( x ¯ ± SD; in the range of 19–87 years of age). The following research tools were used: an interview about awareness of the physical activity recommendations, the Canadian Study of Health and Aging Scale (CSHA-CFS), scales for the assessment of functional status, State-Trait Anxiety Inventory (STAI), Acceptance of Illness Scale (AIS), and the questionnaire of Kidney Disease Quality of Life (KDQOL-SF 1.3). The majority of patients diagnosed with frailty did not follow the physical activity recommendations (79.3%). Quality of life was better in active patients compared to inactive patients, especially in the domains of sleep and physical performance. The severity of trait anxiety was significantly higher in patients who did not follow the recommendations compared to patients who adhered to physical activity recommendations (46.0 ± 10.5 vs. 40.0 ± 8.2; p = 0.021 ). The likelihood of adherence decreased by 1% after each subsequent month of dialysis (odds ratio = 0.99; 95% confidence interval = 0.972–0.999; p = 0.047 ). Adherence was most limited by frailty. Adherence to recommendations on physical activity was affected by: motivation, lower levels of trait anxiety, and better quality of life. Age modified the effect of awareness and acceptance of the disease on adherence to physical activity recommendations.

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Section: Discussionmentioning

confidence: 99%

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Hornik

Duława

2019

IJERPH

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“… 11 The FITNESS trial from the United Kingdom is currently assessing if frailty can be lessened in hemodialysis patients through dietary changes and physical rehabilitation. 21 …”

Section: Discussionmentioning

confidence: 99%

“…11 The FITNESS trial from the United Kingdom is currently assessing if frailty can be lessened in hemodialysis patients through dietary changes and physical rehabilitation. 21 Frail ESKD patients have been previously shown to be less likely to receive a kidney transplant. 1 We found similar results in our univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Use of the FRAIL Questionnaire in Patients With End-Stage Kidney Disease

Jegatheswaran

Chan

Hiremath

et al. 2020

Can J Kidney Health Dis

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Background: Frailty is a clinical phenotype of decreased physiologic reserve that is associated with increased morbidity and mortality. The most meaningful way to assess frailty in patients with end-stage kidney disease (ESKD) is unknown. Objective: To assess the prevalence of frailty in ESKD patients using the easy-to-administer FRAIL scale and, to determine its association with mortality, transplantation, and hospitalization. Design: A cohort study was used. Setting: The Ottawa Hospital, Ottawa, Ontario, Canada, was the setting of this study. Patients: All eligible adult ESKD patients treated with dialysis from August to November 2017 at The Ottawa Hospital were invited to participate. Measurements: The FRAIL scale. Methods: Eligible patients completed an exercise survey with FRAIL questions embedded within the instrument. Number of comorbid illnesses was determined from the electronic medical record and weight loss was calculated from target weight in the patients’ dialysis prescription. Mortality, transplant status, and hospitalizations were ascertained from the electronic medical record 18 months later; differences by frailty status were evaluated using descriptive statistics. Kaplan-Meier and Cox regression models were used to examine the association between frailty and transplant. Results: Of 476 ESKD patients screened, 261 participated; 101 receiving peritoneal dialysis, 135 intermittent hemodialysis, and 25 home hemodialysis. Thirty-nine, 145, and 77 were frail, pre-frail, and not frail, respectively. Employment status, ethnicity, and comorbid illnesses differed significantly by frailty status, but mortality did not. In univariate analysis, frail patients were less likely to be listed for ( P = .05) and to receive a kidney transplant ( P = .02). However, after adjusting for age and modality, frailty was not statistically associated with a decreased likelihood of transplant (Hazard Ratio: 0.15; confidence interval [CI], 0.02-1.15; P = .068). The results were similar when accounting for the competing risk of death ( P = .060). Frail patients were more likely to be hospitalized ( P = .01) and spend more time in the hospital ( P = .04). Limitations: Single-center design with a relatively short follow-up and small sample size limiting the number of variables that could be assessed in analysis. We also excluded patients who were unable to communicate in English or French and those patients with physical limitations such as amputations, potentially affecting generalizability. Conclusions: Frail ESKD patients as identified by the FRAIL scale are less likely to receive a renal transplant; this association diminished statistically after adjusting for age and modality and when accounting for the competing risk of death. Frail patients were at increased risk of hospitalization. Further study with larger patient numbers and longer follow-up is needed to determine the usefulness of the FRAIL scale in predicting adverse outcomes. Trial registration: Not required as this was an observational study.

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“…A detailed description of the FITNESS (Frailty Intervention Trial iN End-Stage patientS on haemodialysis) study has been reported [ 21 ]. Briefly, this first stage is a cross-sectional assessment and long-term follow-up of study participants on maintenance haemodialysis with comprehensive frailty and bio-clinical phenotyping [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

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

Anderson

Qasim

Correa

et al. 2021

Clinical Kidney Journal

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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.

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Frailty Intervention Trial iN End-Stage patientS on haemodialysis (FITNESS): study protocol for a randomised controlled trial

Cited by 17 publications

References 47 publications

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Use of the FRAIL Questionnaire in Patients With End-Stage Kidney Disease

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

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