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Kidney Week

Abstract: TH-OR090

Provider Perception of Frailty Influences Dialysis Modality Choice for Late Stage CKD Patients Receiving Multidisciplinary Care

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Brar, Ranveer Singh, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
  • Whitlock, Reid, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
  • Lerner, Blake, University of Manitoba, Winnipeg, Manitoba, Canada
  • Bohm, Clara, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
  • Komenda, Paul, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
  • Prasad, Bhanu, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
  • Tangri, Navdeep, Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
Background

Frailty is common in patients with Chronic Kidney Disease (CKD) and is associated with 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 decisions surrounding renal replacement therapy modalities in patients with advanced CKD (Stages G4-G5). We sought to determine the prevalence of frailty in patients with advanced CKD and the association of these measures with dialysis modality decisions and mortality.

Methods

We studied 587 patients with advanced CKD who were enrolled in multidisciplinary CKD clinics at 4 centers. We collected demographics, comorbid conditions, and laboratory results in addition to objective [Fried Frailty Criteria and Short Physical Performance Battery (SPPB)], and subjective measures (physician and nurse impression) of frailty. Our primary outcomes were choice of dialysis modality based on provider perception of frailty. Our secondary outcomes were agreement between frailty assessment tools and all-cause mortality.

Results

Our cohort had a mean age of 66.3 and 41% were female. Estimates of frailty prevalence varied as 54.8% of the cohort were considered frail according to SPPB, 33.2% according to Fried, 35.2% according to physician impression, and 32.5% according to nursing impression. Agreement between objective frailty assessments was moderate (κ = 0.42), as was agreement between subjective frailty assessments (κ = 0.47). In unadjusted and adjusted analyses, frailty measured objectively using Fried was associated with mortality (HR 2.15 [95% CI: 1.27-3.62]), and frailty measured subjectively (OR 4.20 [95% CI: 1.88-9.76) was associated with choosing in center hemodialysis.

Conclusion

Frailty is common in patients with advanced CKD, but its operational definition can classify different patients as frail. Patients classified as frail by Fried have a higher risk of death, and patients considered frail by nurses and physicians are 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 the initiation of dialysis is needed.

Funding

  • Government Support - Non-U.S.