Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: a 3-year follow-up of outcomes and associations

Abstract

Background: There remains a lack of evidence based guidelines regarding the benefit of applying scoring systems in the outpatient nephrology setting. As such, we set out to investigate and follow-up the utility of the Clinical Frailty Scale (CFS) for the ongoing management of patients with end stage kidney disease. Aims: To explore the association between frailty, as measured by a Clinical Frailty Score (CFS) 5–8, and long-term outcomes in a cohort of patients with chronic kidney disease (CKD). Methods: This was a 3-year follow-up analysis of a prospective cohort study. This study included participants of age >50 years and with CKD with an estimated glomerular filtration rate <30 mL/min/1.73 m2. The primary outcome included actual end-stage kidney disease (ESKD) management at 3 years (transplantation, haemodialysis, peritoneal dialysis or supportive care). The secondary outcomes include all-cause mortality, hospitalisation rates, and ESKD- and dialysis-related complications. Results: Seventy-nine of 81 patients from the initial study were included; two were lost to follow-up. After 3 years, 18 patients remained on conservative management, 20 on hospital haemodialysis and 13 on peritoneal dialysis. Non-frail patients (CFS 1–4) were twice as likely to have ESKD treatment changes by 3 years. This may carry clinical importance despite not achieving statistical significance (44% (n = 22) vs 22% (n = 4), P = 0.11). Hospitalisation rates were similar between groups (77.8% (n = 14) frail vs 82.0% (n = 41) non-frail; P = 0.74). Mortality was higher in patients living with frailty at baseline (56% (n = 10) vs 8% (n = 4); P ≤ 0.001). Conclusions: Of older adults screened for frailty, those not identified to be frail (CFS 1–4) were twice as likely to have changes in ESKD management as frail patients (CFS 5–8). Three-year mortality was seven times higher (56%) in patients identified as frail at baseline. There were no statistically significant differences in hospitalisation rates or dialysis-related or ESKD-related complications.