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Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools.
Saudi J Kidney Dis Transpl. 2018 Jan-Feb; 29(1):63-70.SJ

Abstract

The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities were collected at baseline and at three months interval for one year. Functional performance was assessed using Karnofsky scale. The Charlson comorbidity index was used to assess comorbid status of each patient. Frailty was assessed using a combination of PRISMA questionnaire and Timed up and Go test. End points were death or start of dialysis at 20-month follow-up. A frail group (n = 58; males = 32, females = 26) and a nonfrail group (n = 46; males = 21, females = 25) were identified. Frailty was prevalent in 53.8% of the selected population. There was no significant difference between both groups in terms of age, gender, comorbidities, hemoglobin, inflammatory markers, or calcium hemostasis. Nine patients chose conservative management in the frail group and six in nonfrail group. Rate of death was significantly higher in the frail group (death = 14) compared to nonfrail group (death = 3; P = 0.01). There was no significant difference between both groups in terms of initiation of dialysis (P = 0.1). Frailty and Charlson comorbidity index were significantly associated with mortality (P = 0.023 and 0.032, respectively). Survival in frail patients who started peritoneal dialysis (PD) was slightly better than those started on hemodialysis (HD) with hazard ratio = 3.23 (P = 0.23). Our study shows that the prevalence of frailty and mortality rate is high among elderly predialysis patients. Frailty and Charlson comorbidity index are independent predictors of outcome in this population. PD might be a better option of dialysis modality compared to HD in the frail population.

Authors+Show Affiliations

Department of Renal Medicine, Heart of England Teaching Hospitals NHS Foundation Trust, Birmingham, UK.Department of Renal Medicine, Heart of England Teaching Hospitals NHS Foundation Trust, Birmingham, UK.Department of Renal Medicine, Heart of England Teaching Hospitals NHS Foundation Trust, Birmingham, UK.Department of Renal Medicine, Heart of England Teaching Hospitals NHS Foundation Trust, Birmingham, UK.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29456209

Citation

Ali, Hatem, et al. "Assessment of Prevalence and Clinical Outcome of Frailty in an Elderly Predialysis Cohort Using Simple Tools." Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, vol. 29, no. 1, 2018, pp. 63-70.
Ali H, Abdelaziz T, Abdelaal F, et al. Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools. Saudi J Kidney Dis Transpl. 2018;29(1):63-70.
Ali, H., Abdelaziz, T., Abdelaal, F., & Baharani, J. (2018). Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools. Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 29(1), 63-70. https://doi.org/10.4103/1319-2442.225175
Ali H, et al. Assessment of Prevalence and Clinical Outcome of Frailty in an Elderly Predialysis Cohort Using Simple Tools. Saudi J Kidney Dis Transpl. 2018 Jan-Feb;29(1):63-70. PubMed PMID: 29456209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools. AU - Ali,Hatem, AU - Abdelaziz,Tarek, AU - Abdelaal,Fatima, AU - Baharani,Jyoti, PY - 2018/2/20/entrez PY - 2018/2/20/pubmed PY - 2019/10/23/medline SP - 63 EP - 70 JF - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia JO - Saudi J Kidney Dis Transpl VL - 29 IS - 1 N2 - The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities were collected at baseline and at three months interval for one year. Functional performance was assessed using Karnofsky scale. The Charlson comorbidity index was used to assess comorbid status of each patient. Frailty was assessed using a combination of PRISMA questionnaire and Timed up and Go test. End points were death or start of dialysis at 20-month follow-up. A frail group (n = 58; males = 32, females = 26) and a nonfrail group (n = 46; males = 21, females = 25) were identified. Frailty was prevalent in 53.8% of the selected population. There was no significant difference between both groups in terms of age, gender, comorbidities, hemoglobin, inflammatory markers, or calcium hemostasis. Nine patients chose conservative management in the frail group and six in nonfrail group. Rate of death was significantly higher in the frail group (death = 14) compared to nonfrail group (death = 3; P = 0.01). There was no significant difference between both groups in terms of initiation of dialysis (P = 0.1). Frailty and Charlson comorbidity index were significantly associated with mortality (P = 0.023 and 0.032, respectively). Survival in frail patients who started peritoneal dialysis (PD) was slightly better than those started on hemodialysis (HD) with hazard ratio = 3.23 (P = 0.23). Our study shows that the prevalence of frailty and mortality rate is high among elderly predialysis patients. Frailty and Charlson comorbidity index are independent predictors of outcome in this population. PD might be a better option of dialysis modality compared to HD in the frail population. SN - 1319-2442 UR - https://www.unboundmedicine.com/medline/citation/29456209/Assessment_of_prevalence_and_clinical_outcome_of_frailty_in_an_elderly_predialysis_cohort_using_simple_tools_ L2 - http://www.sjkdt.org/article.asp?issn=1319-2442;year=2018;volume=29;issue=1;spage=63;epage=70;aulast=Ali DB - PRIME DP - Unbound Medicine ER -