#4687 CORRELATION OF FRAILTY SELF-ASSESSMENT WITH MEASURED FRAILTY USING THE FRIED CRITERIA IN PATIENTS ON DIALYSIS
Authors: Schulte-Kemna Lena , Künzig Miriam , Jazah Mohamed Nooreddin , Kächele Martin , Schroeppel Bernd 
Published: June 2023

Abstract

Background and Aims
Frailty describes a complex syndrome of reduced resistance to stress factors as a consequence of age-related degeneration in various organ systems and is associated with poor clinical outcomes [1]. The European Renal Best Practice Guideline on the management of older patients with CKD recommends a regular assessment of functional status with the intention to identify those who would benefit from a more in-depth geriatric assessment and rehabilitation program [2]. Different frailty screening tools have been evaluated in CKD patients whereas the optimal tool for routine clinical application is not defined. The aim of this study was to evaluate an instrument that can be easily implemented in clinical practice and that can simplify the identification of vulnerable patients on dialysis.

Method
This cross-sectional, multicenter, prospective study included 123 adult patients on hemodialysis. Frailty status was assessed based on modified Fried criteria: self-reported exhaustion, weakness, slow walking speed, low physical activity level and unintentional weight loss [1]. Patients were categorized as frail meeting 3 of the 5 criteria. Patients were also asked to self-assess their frailty status on a 5-point visual analogue scale (VAS). Patients were considered robust selecting “1”, pre-frail “2 and 3”, and frail “4 and 5”. For data-analysis pre-frail and robust patients both using self-assessment and Fried criteria were categorized as “non-frail”. Correlation between Fried-criteria and self-assessment was measured using a contingency table and rank correlation (spearman´s coefficient).

Results
The median age was 68 years, 71% were male and 40% were considered frail using the Fried criteria (Table 1). One patient was on intermittent peritoneal dialysis, all other patients received hemodialysis. There was no difference in frailty status assessed by Fried-criteria according to age, sex, body mass index (BMI) or dialysis vintage. Patients receiving dialysis using a central venous dialysis catheter were more likely to be frail than patients with an arterio-venous fistula or graft. Patients who assessed themselves as frail on the basis of the VAS were significantly more likely to be assigned to this group when measured according to the Fried-criteria. The same applies to the non-frail group (Table 2). The specificity of the VAS was 95%, the sensitivity 39%. This means agreement with the Fried-criteria for patients who considered themselves as non-frail was very high, whereas patients frequently misjudged themselves as frail although they were assigned to the non-frail group when measured according to Fried. Spearman's correlation showed a positive correlation coefficient (0.419) and a significant correlation (2-sided, p &lt; 0.001) between patient self-assessment using the VAS and the Fried-criteria.

Conclusion
Frailty is very common among patients on dialysis and occurs independent of age. The self-assessment by VAS simplifies frailty-screening in patients on dialysis by identifying more robust patients who do not need a time-consuming further evaluation.