Abstract: FR-PO507

Frailty Affects Treatment Decisions and Outcomes for Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Whitlock, Reid, University of Manitoba, Winnipeg, Manitoba, Canada
  • Eng, Frederick, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Brar, Ranveer Singh, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, University of Manitoba, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
  • Bohm, Clara, University of Manitoba, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
Background

Frailty is common in patients with Chronic Kidney Disease (CKD) and leads to accelerated aging. While there have been several studies examining frailty in patients with earlier stages of CKD and those on dialysis, little is known about the prevalence and impact of frailty on outcomes in patients with advanced CKD. We sought to determine the agreement between 3 different frailty measures and the association of these measures with dialysis modality decisions and mortality.

Methods

We studied 508 patients with advanced CKD who were enrolled in CKD clinics at 4 centers. We collected demographics, comorbid conditions, and laboratory results in addition to objective [Modified Fried Frailty Criteria (Fried) and Short Physical Performance Battery (SPPB)], and subjective measures (physician and nurse impression) of frailty. Our primary outcomes were choice of dialysis modality and all-cause mortality.

Results

Our cohort had a median age of 68 (interquartile range: 58, 77) and was 42.9% female. Estimates of frailty prevalence varied as 49.9% of the cohort were considered frail according to SPPB, 29.9% according to Fried, 33.4% according to physician impression, and 28.7% according to nursing impression. Agreement between objective frailty assessments (κ = 0.48) and subjective frailty assessments (κ = 0.46) was moderate. The objective frailty measures were not associated with choice of dialysis modality. In contrast, the subjective physician impression of frailty was associated with choosing hemodialysis (OR 3.74 [95% CI: 1.02-13.66]). The subjective frailty measures were not associated with choice of dialysis modality. Frailty measured objectively using Fried trended toward an association with mortality (OR 1.94 [95% CI: 0.97-3.88]).

Conclusion

In summary, we have demonstrated that the definition of frailty is important, as there is limited agreement between frailty construct and important differences in the relationship of each construct with clinical outcomes. Patients diagnosed as frail by Fried were more likely to die, and patients considered frail by physicians were more likely to choose in-center hemodialysis. Further research to understand the longitudinal trajectory of frailty and its impact on therapeutic choices, morbidity, mortality, and quality of life after initiation of dialysis is needed.

Funding

  • Government Support - Non-U.S.