A comparison of frailty tools in haemodialysis: a prospective cohort study

Anderson, Benjamin Matthew ORCID: 0000-0001-5896-5823 (2023). A comparison of frailty tools in haemodialysis: a prospective cohort study. University of Birmingham. Ph.D.

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Abstract

Frailty is a syndrome of increased vulnerability to poor resolution of homeostasis after stressor event, and is associated with poor patient outcomes such as mortality, hospitalisation, and disability, including in haemodialysis recipients. It has, however, been subject to heterogenous reporting. Commonly cited frailty tools include the Frailty Phenotype (FP), Frailty Index (FI), Edmonton Frail Scale (EFS), and Clinical Frailty Scale (CFS). Each of these utilises different methodologies to determine frailty, and it is not known how they relate to one another in haemodialysis recipients.

The aims of this thesis are to explore frailty by each of these tools in prevalent haemodialysis recipients, both in relationship to one another, and their association with important patient-centred outcomes.

In our single-centre prospective cohort of prevalent (>3-months) haemodialysis recipients, we observed that correlations between frailty tools are modest, and agreement between them upon frailty status was weak. Each of the frailty tools associated with mortality hazard during follow-up. The CFS was the only tool to associate with rates of admission, but equally was the only tool not to associate with length of stay. We identified variable association between frailty tools and ultrasound-derived sarcopenia, and have highlighted that sarcopenia appears to be differentially expressed between males and females receiving haemodialysis. We also identified a novel patient-reported outcome – change in health over the past year – that modulates the association of frailty with mortality, and independently associates with hospitalisation. We propose a notional model of how this may be integrated into frailty assessment for haemodialysis recipients. We have also demonstrated that depression and cognitive impairment are associated with frailty in haemodialysis recipients, and that admissions amongst haemodialysis recipients are highest when cognitive and frailty scores are most discordant.

Frailty is associated with many poor patient outcomes in these analyses, but different frailty tools may be identifying different frailty subtypes. Consensus is required on the optimal frailty tool in haemodialysis recipients to allow comparison and extrapolation of findings across patient cohorts. The Clinical Frailty Scale likely represents the optimal tool in terms of association with negative outcomes and simplicity of use. An evidence-based frailty intervention is urgently required for haemodialysis recipients.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):