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Kidney Week

Abstract: FR-PO535

Association of Subjective Health Assessments with Frailty, ADLs, and iADLs in Advanced CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

  • Baddour, Nicolas, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Robinson-Cohen, Cassianne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Lipworth, Loren, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Bian, Aihua, Vanderbilt University, Nashville, Tennessee, United States
  • Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Subjective health measures (i.e., patient self-rated health (SRH) and the provider surprise question (SQ)) predict key outcomes such as mortality. How these measures relate to frailty and functional status has not been studied in chronic kidney disease (CKD).

Methods

We approached 293 and enrolled 271 outpatients > 60 years of age with non-dialysis dependent CKD stage 4 or 5. Patients were assessed with the SRH questionnaire: “In general, would you say your health is: excellent, very good, good, fair, or poor.” Providers completed patient assessments with the SQ using a 5-point Likert scale: “Would you be surprised if this patient died in the next 12 months?” Frailty was measured using Fried Frailty phenotype and the Clinical Frailty Scale. Activities of daily living (ADLs) and instrumental ADLs (iADLs) were assessed using Katz and Lawton measures. Correlations were evaluated using Spearman’s rank correlation. We used cutoff responses of 'poor' or 'fair' for SRH and 1 or 2 (i.e., not surprised) for the SQ to determine test-characteristics.

Results

About 15% of patients were frail by both Fried Frailty phenotype and Clinical Frailty Scale and 8% and 29% of patients had at least 1 ADL or iADL deficit, respectively. Both SRH and SQ were fairly to moderately correlated with clinical frailty score, Fried Frailty phenotype, iADLs, and weakly correlated with ADLs [Table 1]. SRH (of excellent, very good or good) had a negative predictive value (95% confidence interval) of 0.92 (0.86 to 0.96), 0.92 (0.87 to 0.96), 0.96 (0.91 to 0.98), and 0.83 (0.76 to 0.89) for Fried Frailty phenotype, Clinical Frailty scale, ADL deficiency, and iADL deficiency respectively. SQ had a negative predictive value of 0.87 (0.82 to 0.91), 0.90 (0.86 to 0.94), 0.79 (0.73 to 0.84), and 0.95 (0.92 to 0.98) for Fried Frailty, Clinical Frailty, ADL deficiency, and iADL deficiency respectively.

Conclusion

Single question patient or provider subjective health measures are correlated with frailty and functional status. These measures also may serve as useful tools to rule out frailty and disability in this population.

Spearman Rank Correlations Rho Values (95% confidence interval)
 Fried FrailtyClinical Frailty ScaleADLiADL
Self-Rated Health0.43 (0.32 to 0.52)0.45 (0.35 to 0.54)0.16 (0.04 to 0.26)0.33 (0.23 to 0.44)
Surprise Question0.31 (0.20 to 0.42)0.45 (0.40 to 0.58)0.23 (0.11 to 0.36)0.40 (0.29 to 0.50)

Funding

  • Private Foundation Support