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. 2021 Aug;34(4):1215-1224.
doi: 10.1007/s40620-020-00878-y. Epub 2020 Oct 10.

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

Andrew C Nixon  1   2   3 , Julie Brown  4 , Ailsa Brotherton  5 , Mark Harrison  4 , Judith Todd  6 , Dawn Brannigan  6 , Quinta Ashcroft  7 , Beng So  6 , Neil Pendleton  8 , Leonard Ebah  9 , Sandip Mitra  9   10   11 , Ajay P Dhaygude  6 , Mark E Brady  6
Affiliations

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

Andrew C Nixon et al. J Nephrol. 2021 Aug.

Abstract

Introduction: The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD.

Methods: A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan.

Results: A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20-1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63-2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems.

Conclusions: This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

Keywords: Aging; Chronic kidney disease; Elderly; End stage renal disease; Hemodialysis.

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Conflict of interest statement

Unrelated to this body of work, APD has received lecture fees from speaking at the invitation of MSD and received travel support from Pharmacosmos. ACN reports a grant from Kidney Research UK unrelated to this project. ACN received non-financial support from the NIHR Lancashire Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Figures

Fig. 1
Fig. 1
a Distribution of Clinical Frailty Scale scores for patients with non-dialysis dependent chronic kidney disease. b Distribution of Clinical Frailty Scale scores for patients with dialysis-dependent chronic kidney disease
See this image and copyright information in PMC

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