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Am J Kidney Dis. 2014 Oct;64(4):600-7. doi: 10.1053/j.ajkd.2014.03.016. Epub 2014 Apr 30.

Comparison of self-report-based and physical performance-based frailty definitions among patients receiving maintenance hemodialysis.

Author information

1
United States Renal Data System Nutrition Special Studies Center, University of California, San Francisco, CA; Division of Nephrology, University of California, San Francisco, CA; Nephrology Section, San Francisco VA Medical Center, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA. Electronic address: kirsten.johansen@ucsf.edu.
2
United States Renal Data System Nutrition Special Studies Center, University of California, San Francisco, CA; University of California, San Francisco Division of Nephrology, University of California, Davis, CA.
3
United States Renal Data System Nutrition Special Studies Center, University of California, San Francisco, CA; Division of Nephrology, University of California, San Francisco, CA; Nephrology Section, San Francisco VA Medical Center, University of California, San Francisco, CA.
4
United States Renal Data System Nutrition Special Studies Center, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
5
United States Renal Data System Nutrition Special Studies Center, University of California, San Francisco, CA; Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA.

Erratum in

  • Am J Kidney Dis. 2015 Jul;66(1):178.

Abstract

BACKGROUND:

A well-accepted definition of frailty includes measurements of physical performance, which may limit its clinical utility.

STUDY DESIGN:

In a cross-sectional study, we compared prevalence and patient characteristics based on a frailty definition that uses self-reported function to the classic performance-based definition and developed a modified self-report-based definition.

SETTING & PARTICIPANTS:

Prevalent adult patients receiving hemodialysis in 14 centers around San Francisco and Atlanta in 2009-2011.

INDEX TESTS:

Self-report-based frailty definition in which a score lower than 75 on the Physical Function scale of the 36-Item Short Form Health Survey (SF-36) was substituted for gait speed and grip strength in the classic definition; modified self-report definition with optimized Physical Function score cutoff points derived in a development (one-half) cohort and validated in the other half.

REFERENCE TEST:

Performance-based frailty defined as 3 of the following: weight loss, weakness, exhaustion, low physical activity, and slow gait speed.

RESULTS:

387 (53%) patients were frail based on self-reported function, of whom 209 (29% of the cohort) met the performance-based definition. Only 23 (3%) met the performance-based definition of frailty only. The self-report definition had 90% sensitivity, 64% specificity, 54% positive predictive value, 93% negative predictive value, and 72.5% overall accuracy. Intracellular water per kilogram of body weight and serum albumin, prealbumin, and creatinine levels were highest among nonfrail individuals, intermediate among those who were frail by self-report, and lowest among those who also were frail by performance. Age, percentage of body fat, and C-reactive protein level followed an opposite pattern. The modified self-report definition had better accuracy (84%; 95% CI, 79%-89%) and superior specificity (88%) and positive predictive value (67%).

LIMITATIONS:

Our study did not address prediction of outcomes.

CONCLUSIONS:

Patients who meet the self-report-based but not the performance-based definition of frailty may represent an intermediate phenotype. A modified self-report definition can improve the accuracy of a questionnaire-based method of defining frailty.

KEYWORDS:

Frailty; end-stage renal disease (ESRD); hemodialysis; physical activity; physical function; physical performance; self-reported function

Comment in

PMID:
24793033
PMCID:
PMC4177262
DOI:
10.1053/j.ajkd.2014.03.016
[Indexed for MEDLINE]
Free PMC Article

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