#4781 FRAILTY IN PERITONEAL DIALYSIS: PREVALENCE AND PREDICTION FACTORS
Authors: Piedade Ana , Domingues Patrícia , Dias Bruno Fraga , Inácio António Silva , Mendes Beatriz , Parreira Lúcia , Carvalho Maria João , Rodrigues Anabela , Assunção José , Santos Patricia Valério , Farinha Ana 
Published: June 2023

Abstract

Background and Aims
Frailty is a clinical syndrome characterized by a state of increased vulnerability and risk of adverse outcomes following a stress, which exerts a heavy economic and social burden. The identification of this syndrome is done throught validated tools. Although frailty is associated with advanced age, certain conditions that produce age-like changes can lead to a state of frailty at younger ages. The presence of multiple comorbidities increases frailty risk. Also, low levels of albumin, even in the normal range, have been related to greater frailty and its levels have been used to assess frailty. Chronic kidney disease is associated with higher prevalence of frailty. However, little has been reported about frailty prevalence in peritoneal dialysis population. Our aim was to access the prevalence of frail and vulnerable PD patients using the Edmonton Frailty Scale (EFS) and to identify prediction factors.

Method
In a retrospective cohort study, we assessed frailty in PD patients from 2 center in Portugal by a validated frailty score (Edmonton Frailty Scale-EFS). We also collected information that could contribute to frailty in these patients. Linear and logistic regressions were used to access frailty predictors. Receiver operating characteristics (ROC) curve was used to access accuracy of those predictors.

Results
We included 74 PD patients, 51,5% male, mean age 53,9 ± 15,1 years, median body max index 25,2 ± 4,3 Kg/m2. Median CCI was 4 [interquartile range (IQR) of 3]. Fifty-three patients (71,6%) were classified as robust (non-frail), 11 as vulnerable, and 10 as frail (8 mildly and 2 moderate). Patients were divided into two groups: A group included robust (non-frail) patients; B group included vulnerable and frail ones. Age, sex distribution, IMC, diabetes mellitus prevalence, variables related to PD (efficacy, vintage, modality and complications), and levels of hemoglobin, phosphorus, potassium and C-reactive protein were similar between the groups. Non frail patients presented significantly higher albumin levels and lower CCI (p-value &lt; 0,05). A linear regression was performed to ascertain the effects of CCI and albumin: CCI was an independent predictor for frailty/vulnerability, accessed by EFS (for each point in CCI, there was an increase of 0,5 points in EFS). Albumin did not show a significant effect defining frailty in our sample. ROC curve showed a high accuracy for CCI to identify frail/ vulnerable patients (AUC 0,817).

Conclusion
In our sample, CCI was an independent factor for frailty/vulnerability classified through EFS. In fact, it had a high accuracy to identify those patients, with a high sensibility. This means that CCI could be used as an acceptable screening test. However, the prevalence of frail/vulnerable patients was low in our sample. A larger one will allow to determine confirm if certain comorbidities, such as diabetes mellitus, or variables related to dialysis technique, are correlated with frailty. Furthermore, a larger sample would be essential to confirm whether albumin is, after all, a good predictor of frailty in the PD population, which was not confirmed in this work.