122CLINICIAN ATTITUDES REGARDING THE UTILITY OF FRAILTY TOOLS IN MANAGING OLDER ADULTS WITH END STAGE KIDNEY DISEASE: LITERATURE REVIEW AND SURVEY STUDY

Abstract

Background: The incidence and prevalence of End Stage Kidney Disease (ESKD) in Australia is rising, with the fastest increase seen amongst older adults, above the age of 65 years. However, the rate of increase of the number of older adults on dialysis has slowed over the last five years. This maybe owing to emerging evidence of the limited benefit and potential deleterious effects of dialysis initiation in frail older adults. Frailty, a clinical syndrome of increased vulnerability to adverse health outcomes, is predictive of survival in the renal population. However, there is not yet a widely accepted frailty tool for routine use in managing older adults with ESKD. Aims: To describe clinicians' attitudes and practices in using a frailty tool as a decisionmaking aid, in older adults with ESKD approaching the need for dialysis. Methods: A literature search was conducted using three online databases PubMed, Embase and Cochrane Library, with a focus on frailty assessment in ESKD. Eight studies were included in the final literature review following consideration of inclusion and exclusion criteria. A questionnaire was subsequently developed, with input from two nephrologists and three geriatricians. A prospective cohort study was undertaken. Participants were clinicians in geriatrics and nephrology. A secure web-based survey was conducted over a 12-week period from 8th May to 31st July 2017. Results: 133 of 1161 clinicians responded, reflecting a crude response rate of 11.3%. The majority (81%) were geriatricians. Sixty-one percent of respondents usually or always assessed frailty. Only 36% routinely used a validated frailty tool. The most commonly used frailty tool was the Clinical Frailty Scale. Simplicity (92.3%) and utility as a bed side test (93.8%) were important attributes of a frailty tool. Conclusion: There exist valid frailty assessments which can be used to prognosticate ESKD patients. Clinicians value the concept of frailty. However, frailty tools appear underutilised. If widely accessible and simple to complete as a bedside test, frailty assessment can be valuable in managing older adults with ESKD.