Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr 7;11(4):626-32.
doi: 10.2215/CJN.03710415. Epub 2016 Jan 20.

Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis

Kirsten L Johansen  1 , Lorien S Dalrymple  2 , David Glidden  3 , Cynthia Delgado  4 , George A Kaysen  2 , Barbara Grimes  3 , Glenn M Chertow  5
Affiliations

Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis

Kirsten L Johansen et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Frailty is common among patients on dialysis and increases vulnerability to dependency and death.

Design, setting, participants, & measurements: We examined the predictive ability of frailty on the basis of physical performance and self-reported function in participants of a US Renal Data System special study that enrolled a convenience sample of 771 prevalent patients on hemodialysis from 14 facilities in the Atlanta and northern California areas from 2009 to 2011. Performance-based frailty was assessed using direct measures of grip strength (weakness) and gait speed along with weight loss, exhaustion, and low physical activity; poor self-reported function was substituted for weakness and slow gait speed in the self-reported function-based definition. For both definitions, patients meeting three or more criteria were considered frail.

Results: The mean age of 762 patients included in analyses was 57.1±14.2 years old; 240 patients (31%) met the physical performance-based definition of frailty, and 396 (52%) met the self-reported function-based definition. There were 106 deaths during 1.7 (interquartile range, 1.4-2.4) years of follow-up. After adjusting for demographic and clinical characteristics, the hazard ratio (HR) for mortality for the performance-based definition (2.16; 95% confidence interval [95% CI], 1.41 to 3.29) was slightly higher than that of the self-reported function-based definition (HR, 1.93; 95% CI, 1.24 to 3.00). Patients who met the self-report-based definition but not the physical performance definition of frailty (n=192) were not at statistically significantly higher risk of mortality than those who were not frail by either definition (n=330; HR, 1.41; 95% CI, 0.81 to 2.45), but those who met both definitions of frailty (n=204) were at significantly higher risk (HR, 2.46; 95% CI, 1.51 to 4.01).

Conclusions: Frailty, defined using either direct tests of physical performance or self-reported physical function, was associated with higher mortality among patients receiving hemodialysis. Future studies are needed to determine the utility of assessing frailty in clinical practice.

Keywords: ESRD; fatigue; follow-up studies; gait; geriatric nephrology; hand strength; health status indicators; hemodialysis; humans; physical fitness; survival.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Number of individual frailty components and overall frailty prevalence according to the performance-based and self-report-based definitions. (A) Histogram of raw frailty scores. (B) Venn diagram of frailty prevalence. The dashed circle represents frailty defined by physical performance (Fried Frailty Index) and the dotted circle represents a frailty designation using patients’ self-reports of physical function.
See this image and copyright information in PMC

References

    1. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J: Frailty consensus: A call to action. J Am Med Dir Assoc 14: 392–397, 2013 - PMC - PubMed
    1. Rodríguez-Mañas L, Féart C, Mann G, Viña J, Chatterji S, Chodzko-Zajko W, Gonzalez-Colaço Harmand M, Bergman H, Carcaillon L, Nicholson C, Scuteri A, Sinclair A, Pelaez M, Van der Cammen T, Beland F, Bickenbach J, Delamarche P, Ferrucci L, Fried LP, Gutiérrez-Robledo LM, Rockwood K, Rodríguez Artalejo F, Serviddio G, Vega E, FOD-CC group (Appendix 1) : Searching for an operational definition of frailty: A Delphi method based consensus statement: The frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 68: 62–67, 2013 - PMC - PubMed
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group : Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–M156, 2001 - PubMed
    1. Shlipak MG, Stehman-Breen C, Fried LF, Song X, Siscovick D, Fried LP, Psaty BM, Newman AB: The presence of frailty in elderly persons with chronic renal insufficiency. Am J Kidney Dis 43: 861–867, 2004 - PubMed
    1. McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, Walston JD, Segev DL: Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc 61: 896–901, 2013 - PMC - PubMed

Publication types