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Frailty in end-stage renal disease: comparing patient, caregiver, and clinician perspectives.
BMC Nephrol. 2017 May 02; 18(1):148.BN

Abstract

BACKGROUND

Frailty 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.

METHODS

A 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.

RESULTS

A 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).

CONCLUSIONS

Frailty 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.

Authors+Show Affiliations

Division of Nephrology, Dalhousie University, 5070 Dickson Building, 5820 University Avenue, Halifax, B3H 2Y9, NS, Canada.Nova Scotia Health Authority, Halifax, NS, Canada.Division of Nephrology, Dalhousie University, 5070 Dickson Building, 5820 University Avenue, Halifax, B3H 2Y9, NS, Canada.Division of Internal Medicine, Dalhousie University, Halifax, NS, Canada.Division of Internal Medicine, Dalhousie University, Halifax, NS, Canada.Nova Scotia Health Authority, Halifax, NS, Canada.Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.Division of Nephrology, Dalhousie University, 5070 Dickson Building, 5820 University Avenue, Halifax, B3H 2Y9, NS, Canada. ktennankore@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28464924

Citation

Clark, David A., et al. "Frailty in End-stage Renal Disease: Comparing Patient, Caregiver, and Clinician Perspectives." BMC Nephrology, vol. 18, no. 1, 2017, p. 148.
Clark DA, Khan U, Kiberd BA, et al. Frailty in end-stage renal disease: comparing patient, caregiver, and clinician perspectives. BMC Nephrol. 2017;18(1):148.
Clark, D. A., Khan, U., Kiberd, B. A., Turner, C. C., Dixon, A., Landry, D., Moffatt, H. C., Moorhouse, P. A., & Tennankore, K. K. (2017). Frailty in end-stage renal disease: comparing patient, caregiver, and clinician perspectives. BMC Nephrology, 18(1), 148. https://doi.org/10.1186/s12882-017-0558-x
Clark DA, et al. Frailty in End-stage Renal Disease: Comparing Patient, Caregiver, and Clinician Perspectives. BMC Nephrol. 2017 May 2;18(1):148. PubMed PMID: 28464924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty in end-stage renal disease: comparing patient, caregiver, and clinician perspectives. AU - Clark,David A, AU - Khan,Usman, AU - Kiberd,Bryce A, AU - Turner,Colin C, AU - Dixon,Alison, AU - Landry,David, AU - Moffatt,Heather C, AU - Moorhouse,Paige A, AU - Tennankore,Karthik K, Y1 - 2017/05/02/ PY - 2016/10/18/received PY - 2017/04/18/accepted PY - 2017/5/4/entrez PY - 2017/5/4/pubmed PY - 2018/3/6/medline KW - Clinical frailty scale KW - Dialysis KW - Frailty KW - Frailty index KW - Fried phenotype SP - 148 EP - 148 JF - BMC nephrology JO - BMC Nephrol VL - 18 IS - 1 N2 - BACKGROUND: Frailty 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. METHODS: A 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. RESULTS: A 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). CONCLUSIONS: Frailty 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. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/28464924/Frailty_in_end_stage_renal_disease:_comparing_patient_caregiver_and_clinician_perspectives_ L2 - https://www.biomedcentral.com/1471-2369/18/148 DB - PRIME DP - Unbound Medicine ER -