Abstract: FR-PO919

A Frailty Screening Tool for Use in CKD by Medical and Nursing Staff

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Nixon, Andrew, University of Manchester, Manchester, United Kingdom
  • Bampouras, Theodoros M, University of Cumbria, Lancaster, United Kingdom
  • Petrie, Alastair Ross, University of Cumbria, Lancaster, United Kingdom
  • Afolabi, Atinuke Janet, University of Cumbria, Lancaster, United Kingdom
  • Pendleton, Neil, University of Manchester, Manchester, United Kingdom
  • Mitra, Sandip, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
  • Dhaygude, Ajay Prabhakar, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
Background

Frailty is associated with adverse clinical outcomes in chronic kidney disease (CKD) including an increased risk of hospitalisation and mortality. Nephrologists need a well-validated frailty screening tool.

Methods

Fifty-eight dialysis-dependent CKD and pre-dialysis stage 4 and 5 CKD patients were recruited. Patients were assessed by a doctor and nurses using the Clinical Frailty Scale (CFS). Frailty was also assessed using two operationalised frailty definitions: the frailty phenotype (FP) and the frailty index (FI). CFS scores were compared with FP and FI scores and ROC curves were calculated.

Results

Median age was 70 years old (IQR: 58.75-77.00) with 28 male patients. Half were receiving haemodialysis. Mean Charlson Comorbidity Index was 3.12 (SD: 1.29). Using the CFS, 29% were idenitified as frail by a doctor and 31% by nurses. Using the FP, frailty prevalance was 24%. Mean FI was 0.32 (SD: 0.13). Doctor and nurse CFS scores correlated well with each other (r=0.81, 95% CI: 0.70-0.89). Doctor CFS scores correlated well with FP (r=0.80, 95% CI: 0.70- 0.87) and FI (r=0.85, 95% CI: 0.75-0.92) scores. Nurse CFS scores correlated moderately well with FP (r=0.66, 95% CI: 0.51-0.77) and FI (r=0.67, 95% CI: 0.52-0.79) scores. The ROC AUC was 0.90 (95% CI: 0.82-0.98) for the doctor CFS and 0.81 (95% CI: 0.70-0.93) for the nurse CFS (figure 1). A CFS score ≥4 gave a sensitivity of 1.00 and 1.00 with a specificity of 0.41 and 0.43 for identifying frailty (as defined by the FP) by a doctor and nurse, respectively.

Conclusion

The CFS is a useful frailty screening tool in those with CKD and can be effectively used by medical and nursing staff. Further study is needed to evaluate its ability to risk stratify patients prior to the commencement of renal replacement therapy.

Figure 1. Using the CFS to Identify Frailty.