TY - JOUR
T1 - Engaging clinicians and patients to assess and improve frailty measurement in adults with end stage renal disease
AU - Van Pilsum Rasmussen, Sarah
AU - Konel, Jonathan
AU - Warsame, Fatima
AU - Ying, Hao
AU - Buta, Brian
AU - Haugen, Christine
AU - King, Elizabeth
AU - DiBrito, Sandra
AU - Varadhan, Ravi
AU - Rodríguez-Mañas, Leocadio
AU - Walston, Jeremy D.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/1/12
Y1 - 2018/1/12
N2 - Background: The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. However, these 5 components may not fully capture physiologic reserve in this population. We aimed to ascertain opinions of ESRD clinicians and patients about the usefulness of the Fried frailty phenotype and interventions to improve frailty in ESRD patients, and to identify novel components to further characterize frailty in ESRD. Methods: Clinicians who treat adults with ESRD completed a 2-round Delphi study (n = 41 and n = 36, respectively; response rate = 87%). ESRD patients completed a survey at transplant evaluation (n = 460; response rate = 81%). We compared clinician and patient opinions on the constituent components of frailty. Results: Clinicians were more likely than patients to say that ESRD makes patients frail (97.6% vs. 60.2%). There was consensus among clinicians that exhaustion, low physical activity, slow walking speed, and poor grip strength characterize frailty in ESRD patients; however, 29% of clinicians thought weight loss was not relevant. Patients were less likely than clinicians to say that the 5 Fried frailty components were relevant. Clinicians identified 10 new ESRD-specific potential components including falls (64%), physical decline (61%), and cognitive impairment (39%). Clinicians (83%) and patients (80%) agreed that intradialytic foot-peddlers might make ESRD patients less frail. Conclusions: There was consensus among clinicians and moderate consensus among patients that frailty is more common in ESRD. Weight loss was not seen as relevant, but new components were identified. These findings are first steps in refining the frailty phenotype and identifying interventions to improve physiologic reserve specific to ESRD patients.
AB - Background: The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. However, these 5 components may not fully capture physiologic reserve in this population. We aimed to ascertain opinions of ESRD clinicians and patients about the usefulness of the Fried frailty phenotype and interventions to improve frailty in ESRD patients, and to identify novel components to further characterize frailty in ESRD. Methods: Clinicians who treat adults with ESRD completed a 2-round Delphi study (n = 41 and n = 36, respectively; response rate = 87%). ESRD patients completed a survey at transplant evaluation (n = 460; response rate = 81%). We compared clinician and patient opinions on the constituent components of frailty. Results: Clinicians were more likely than patients to say that ESRD makes patients frail (97.6% vs. 60.2%). There was consensus among clinicians that exhaustion, low physical activity, slow walking speed, and poor grip strength characterize frailty in ESRD patients; however, 29% of clinicians thought weight loss was not relevant. Patients were less likely than clinicians to say that the 5 Fried frailty components were relevant. Clinicians identified 10 new ESRD-specific potential components including falls (64%), physical decline (61%), and cognitive impairment (39%). Clinicians (83%) and patients (80%) agreed that intradialytic foot-peddlers might make ESRD patients less frail. Conclusions: There was consensus among clinicians and moderate consensus among patients that frailty is more common in ESRD. Weight loss was not seen as relevant, but new components were identified. These findings are first steps in refining the frailty phenotype and identifying interventions to improve physiologic reserve specific to ESRD patients.
KW - ESRD
KW - Frailty
KW - Hemodialysis
UR - http://www.scopus.com/inward/record.url?scp=85040463080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040463080&partnerID=8YFLogxK
U2 - 10.1186/s12882-017-0806-0
DO - 10.1186/s12882-017-0806-0
M3 - Article
C2 - 29329515
AN - SCOPUS:85040463080
SN - 1471-2369
VL - 19
JO - BMC nephrology
JF - BMC nephrology
IS - 1
M1 - 8
ER -