Prevalence of Frailty in (Pre-)Dialysis patients.

Drost, D. (Diederik) (2014) Prevalence of Frailty in (Pre-)Dialysis patients. thesis, Medicine.

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Abstract

Background With population ageing there is an increasing number of elderly patients with end stage renal disease (ESRD) who are dialysis dependent. Prognosis of elder dialysis patients is poor with high risk for functional decline and mortality. Frailty, a state of high vulnerability due to decrease in physiological reserves leading to failure of homeostatic balance, seems to be a possible good predictor of those patients who need extra interventions or who possible will not benefit from dialysis treatment. Limited research is done on frailty in this population and prevalence rates differ widely, between 24% and more than two third in hemodialysis patients. Also, multiple screening instruments are increasingly being used for prognostication and intervention but discriminative value in the ESRD population is not known. Objectives First, to estimate the prevalence of frailty in ESRD patients and patients’ characteristics associated with frailty. Second, to test three frailty screening instruments for frailty and their discriminative value for use in the ESRD population. Study design Cross-sectional study in patients, aged ≥ 18 years, receiving hemodialysis, peritoneal dialysis and pre-dialysis care between Sept 2013 and Dec 2013 in a single dialysis center in Apeldoorn, the Netherlands. Method Frailty assessment according to a frailty index, and for comparison according to the frailty phenotype, including a questionnaire, function tests and documented comorbidity. Three screening instruments, the Groningen Frailty Indicator (GFI), the VMS vulnerable elderly (VMS) and the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), for frailty were implemented and tested for discriminative value with the frailty index as gold standard. Results Prevalence of frailty was 36.8% among 95 participants with ESRD. Frailty prevalence among participants aged ≥ 65 years was 43.6% and for participants aged < 65 years 27.5%. Frail participants were more likely to be female (OR: 3.3, 95%CI: 1.3-8.0) and have a high Charlson comorbidity index score of ≥5 (OR:2.6, 95%CI: 1.0-6.6). The frailty index identified different but overlapping participants as frail compared with the frailty phenotype; 62.5% of frail participants according to frailty index were also found frail according to the frailty phenotype. The GFI had the highest sensitivity among the three instruments, with sensitivity and specificity of 89% and 57%, 83% and 77%, 77% and 67% for the GFI, ISAR-HP and VMS respectively. Conclusions Prevalence of frailty among young and elderly ESRD patients is high, being female and a Charlson comorbidity index score of ≥5 is associated with frailty. Different screening instruments can be used in the ESRD population; the GFI has good discriminative value in screening for risk of frailty in the ESRD population. Due its high prevalence and possible good methods to identify ESRD patients who are at high risk for frailty, further research should focus on the role of frailty in clinical decision making and interventions aimed to prevent the development or deterioration of frailty in the ESRD population.

Item Type:	Thesis (Thesis)
Supervisor name:	Zeeman, Dr. M. and Internist ouderengeneeskunde and Deventer Ziekenhuis
Supervisor name:	Munster, Dr. B.C. van and Internist ouderengeneeskunde and Gelre Ziekenhuizen Apeldoorn
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/38

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