The Clinical Frailty Scale (CFS) is a tool used to screen for frailty, which is linked to hospital stays and death in haemodialysis patients. This study compared two methods of assessing frailty: a standard CFS score from clinical interviews and a multidisciplinary team (MDT) assessment during haemodialysis quality meetings. Researchers tracked 453 patients over nearly two years. They found that the standard CFS identified more patients as frail than the MDT method. Both methods showed that increased frailty was linked to higher hospitalisation rates and mortality. However, the MDT method was less accurate and less consistent. The study highlights the need for standardised CFS assessment in haemodialysis to improve decision-making and patient care.

Abstract

Background

The Clinical Frailty Scale (CFS) is a commonly utilised frailty screening tool that has been associated with hospitalisation and mortality in haemodialysis recipients but is subject to heterogenous methodologies including subjective clinician opinion. The aims of this study were to (i) examine the accuracy of a subjective, multidisciplinary assessment of CFS at haemodialysis Quality Assurance (QA) meetings (CFS-MDT), compared with a standard CFS score via clinical interview, and (ii) ascertain the associations of these scores with hospitalisation and mortality.

Methods

We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalisation. Frailty was assessed using the CFS after structured clinical interview. The CFS-MDT was derived from consensus at haemodialysis QA meetings, involving dialysis nurses, dietitians, and nephrologists.

Results

453 participants were followed-up for a median of 685 days (IQR 544–812), during which there were 96 (21.2%) deaths, and 1136 hospitalisations shared between 327 (72.1%) participants. Frailty was identified in 246 (54.3%) participants via CFS, but only 120 (26.5%) via CFS-MDT. There was weak correlation (Spearman Rho 0.485, P < 0.001) on raw frailty scores and minimal agreement (Cohen’s κ = 0.274, P < 0.001) on categorisation of frail, vulnerable and robust between the CFS and CFS-MDT. Increasing frailty was associated with higher rates of hospitalisation for the CFS (IRR 1.26, 95% C.I. 1.17–1.36, P = 0.016) and CFS-MDT (IRR 1.10, 1.02–1.19, P = 0.02), but only the CFS-MDT was associated with nights spent in hospital (IRR 1.22, 95% C.I. 1.08–1.38, P = 0.001). Both scores were associated with mortality (CFS HR 1.31, 95% C.I. 1.09–1.57, P = 0.004; CFS-MDT HR 1.36, 95% C.I. 1.16–1.59, P < 0.001).

Conclusions

Assessment of CFS is deeply affected by the underlying methodology, with the potential to profoundly affect decision-making. The CFS-MDT appears to be a weak alternative to conventional CFS. Standardisation of CFS use is of paramount importance in clinical and research practice in haemodialysis.

Authors: Benjamin M Anderson, Muhammad Qasim, Gonzalo Correa, Felicity Evison, Suzy Gallier, Charles J Ferro, Thomas A Jackson, Adnan Sharif