The online version of this article (https://doi.org/10.1186/s12882-017-0806-0) contains supplementary material, which is available to authorized users.
The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. However, these 5 components may not fully capture physiologic reserve in this population. We aimed to ascertain opinions of ESRD clinicians and patients about the usefulness of the Fried frailty phenotype and interventions to improve frailty in ESRD patients, and to identify novel components to further characterize frailty in ESRD.
Clinicians who treat adults with ESRD completed a 2-round Delphi study (n = 41 and n = 36, respectively; response rate = 87%). ESRD patients completed a survey at transplant evaluation (n = 460; response rate = 81%). We compared clinician and patient opinions on the constituent components of frailty.
Clinicians were more likely than patients to say that ESRD makes patients frail (97.6% vs. 60.2%). There was consensus among clinicians that exhaustion, low physical activity, slow walking speed, and poor grip strength characterize frailty in ESRD patients; however, 29% of clinicians thought weight loss was not relevant. Patients were less likely than clinicians to say that the 5 Fried frailty components were relevant. Clinicians identified 10 new ESRD-specific potential components including falls (64%), physical decline (61%), and cognitive impairment (39%). Clinicians (83%) and patients (80%) agreed that intradialytic foot-peddlers might make ESRD patients less frail.
There was consensus among clinicians and moderate consensus among patients that frailty is more common in ESRD. Weight loss was not seen as relevant, but new components were identified. These findings are first steps in refining the frailty phenotype and identifying interventions to improve physiologic reserve specific to ESRD patients.
Additional file 1: Table S1. Delphi Study Surveys of Clinicians who treat adults with ESRD: First Survey. (DOCX 86 kb)12882_2017_806_MOESM1_ESM.docx
Additional file 2: Table S2. Validated Fried Frailty Assessment Tool. (DOCX 20 kb)12882_2017_806_MOESM2_ESM.docx
Additional file 3: Table S3. Delphi Study Survey of Clinicians who treat adults with ESRD: Second Survey. (DOCX 74 kb)12882_2017_806_MOESM3_ESM.docx
Additional file 4: Table S4. Description of data: Survey of Adults with ESRD undergoing hemodialysis. (DOCX 83 kb)12882_2017_806_MOESM4_ESM.docx
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- Engaging clinicians and patients to assess and improve frailty measurement in adults with end stage renal disease
Sarah Van Pilsum Rasmussen
Jeremy D. Walston
Dorry L. Segev
Mara A. McAdams-DeMarco
- BioMed Central
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