Investigating the relationship between FRailty And Quality of LIfe in patients with heart faiLure and CKD (FRAIL study)

Abstract

Aims: Patients with chronic kidney disease (CKD) or heart failure (HF) are disproportionally affected by frailty, an independent predictor of morbidity. The prevalence of frailty and its impact on quality of life (QoL) in a unique population of patients with both CKD and HF (CKD-HF) is unclear. The aim of this study was to investigate the association between frailty and QoL in patients with CKD-HF.

Methods and results: Patients were identified from a tertiary care cardiorenal clinic. Eligible patients had CKD-HF with a stable estimated glomerular filtration rate of <60 mL/min/1.73². Data were collected from each participant at one point in time using surveys delivered by study personnel between 14 July 2022 and 31 March 2023. Frailty was defined as Modified Frailty Phenotype (MFP) score ≥3. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to assess QoL. Demographic data were retrospectively collected from electronic patient records. Demographics and QoL were compared between frail and non-frail cohorts using Pearson's R and Student's t-test (two-tailed, alpha-priori = 0.05). One hundred five participants consented, and 103 completed the questionnaires in full. Amongst the 103 participants, 49.5% (n = 51) were frail. Frailty was related to sex (P = 0.021) and medication count (P = 0.007), however not to other clinical measures, including estimated glomerular filtration rate (P = 0.437) and ejection fraction (P = 0.911). Frail patients reported poorer QoL across physical functioning (P < 0.001), general health (P < 0.001), bodily pain (P = 0.004), social functioning (P < 0.001), and energy levels (P < 0.001), however not emotional wellbeing (P = 0.058); 51.5% cited 'better quality of life' as their healthcare priority, over longer survival (23.3%) or avoiding hospital admissions (22.3%). This was consistent across frail and non-frail groups.

Conclusions: A large proportion of CKD-HF patients are frail, regardless of disease severity, and more susceptible to significantly poorer QoL across physical and social domains. Improving QoL is the priority of patients across both frail and non-frail cohorts, further emphasizing the need for prompt recognition of frailty as well as possible intervention and prevention.

Keywords: Chronic kidney failure; Frailty; Heart failure; Observational; Quality of life.

Figure 1

Recruitment flow chart.

Figure 2

Graphs representing the relationship between frailty and several parameters of HR‐QOL: energy, general health, physical functioning, social functioning, bodily pain, and mental health.

Figure 3

Graphs representing the relationship between chronic kidney disease stages and several parameters of HR‐QOL: general health, energy, physical functioning, social functioning, bodily pain, and emotional wellbeing.

Figure 4

Graphs representing the relationship between numbers of medications and several parameters of HR‐QOL: general health, energy, physical functioning, social functioning, bodily pain, and emotional wellbeing.

Figure 5

Participants order of priority when asked to prioritize ‘Longer Survival’, ‘Better Quality of Life’ or ‘Reduced Hospital Admissions’. The majority of respondents (53%) cited ‘Better Quality of Life’ as their first priority, when it came to planning their healthcare.