P0253FRAILTY SCREENING TOOLS, FUNCTIONAL STATUS AND LIFE EXPECTANCY IN ELDERLY PATIENTS WITH PRE-DIALYSIS ADVANCED CHRONIC KIDNEY DISEASE
Authors: Hussien Hani , Apetrii Mugurel , Onofriescu Mihai , Nastasa Andra , Mircea Gabriel , Teodor Iuliana , Apascaritei Irina , Covic Adrian 
Published: June 2020

Abstract

Background and Aims
Patients with chronic kidney disease (CKD) are at high risk of being frail, which is associated with poor outcomes including falls, low functional status, decreased quality of life, hospitalization, and mortality. Furthermore, the presence of frailty might decrease the potential benefits of renal replacement therapy initiation or even leads to worse outcomes. Currently, there are over 51 known tools for screening of frailty in the general population. The aim of this study was to describe the prevalence of frailty in elderly patients with pre-dialysis advanced CKD (G4 and G5) according to different frailty assessment tools from the 4 main categories of frailty screening: self-reporting questionnaires, subjective scores, simple single physical tools and complex scores. Also, we compared the functional status and the 10-year survival expectancy in frail Vs non-frail patients.

Method
In this cross-sectional study, we included patients from the Outpatient Department from Nephrology unit in a tertiary health facility “Dr C. I. Parhon Clinical Hospital’’ who were ≥65 years old with CKD G4–5 (eGFR &lt; 30 ml/min/1.73 m2 using the CKD-EPI formula) on at least two occasions in the previous 3 months prior to the time of inclusion. The frailty was assessed using one method from each frailty screening category: self-reporting score as PRISMA-7, subjective score as Clinical Frailty Scale (CFS), a complex score as Frailty Phenotype (FP) and two simple single physical tools as gait speed in 4.5 meters (GS) and handgrip strength using a dynamometer (HGS). All participants had the Charlson Comorbidity Index (CCI) score calculated and the Karnofsky Performance Status Scale (KPS) performed.

Results
We included a total number of 201 patients, of which 53.23 % were males with a mean age of 73.9 ± 6.8 years. Mean eGFR was 19 ± 6.21 ml/min/1.73 m2. Using the three proposed scores, 69.15% of patients were at risk of frailty using PRISMA-7, compared to 45.77% and 40.3% who were frail according to CFS and FP respectively. HGS was weak in 51.74% of the patients while only 35.82% had slow GS. Half of the patients (50.25 %) had a Karnofsky score of ≤ 60, which corresponds to different degrees of losing autonomy.
Comparing functional status in frail Vs. non-frail patients, we found that the mean KPS points for non-frail patients was similar regardless of the used tool: 73 according to FP, 75 according to CFS and 76 points according to PRISMA 7. Same results were obtained in patients with normal GS or with a normal HGS with mean KPS of 71 points.
The 10-year survival expectancy was significantly lower in frail patients with similar mean values: 20% for both CFS and FP and 26 % for PRISMA-7, compared to non-frail patients with a predicted survival of 43% for CFS, 41% for FP and 47% for PRISMA-7. Similarly, in patients with slow GS and weak HGS, the mean CCI was 24 % for both groups, in comparison with 42% and 37 % in patients with normal HGS and normal GS respectively.

Conclusion
To the best of our knowledge, this is the first study to compare five frailty assessment tools in terms of functional status and life expectancy in elderly patients with pre-dialysis advanced CKD, but taking into consideration that those tools must be from different frailty assessment categories. Our study has shown that non-frail elderly patients with pre-dialysis advanced CKD have enjoyed a significantly higher degree of autonomy as well as higher 10-year survival expectancy in comparison with frail patients. The proposed frailty assessment tools have shown very close results in terms of functional status and life expectancy regardless of the complexity of the tool being used. Therefore, we suggest that using a simple self-reporting tool as PRISMA-7 or a simple single physical tool like handgrip strength or gait speed would be appropriate for screening of frailty in elderly patients with pre-dialysis advanced CKD who are at a high risk of losing autonomy and lower life expectancy.