This study examined the relationship between frailty, self-reported health, and risk of hospitalization and death in haemodialysis patients. Researchers studied 485 patients using various frailty assessment tools and monitored them for nearly two years. They found that increased frailty was linked to higher mortality rates, especially in patients who reported their health as the same or worse. The Clinical Frailty Scale (CFS) was the only tool associated with hospitalization rates. The study highlights the importance of considering self-reported health along with frailty assessments to better identify the most at-risk patients. This can help improve care and outcomes for haemodialysis patients.

ABSTRACT

Background

Frailty among haemodialysis patients is associated with hospitalization and mortality, but high frailty prevalence suggests further discrimination of risk is required. We hypothesized that incorporation of self-reported health with frailty measurement may aid risk stratification.

Methods

Prospective cohort study of 485 prevalent haemodialysis recipients linked to English national datasets. Frailty Phenotype (FP), Frailty Index (FI), Edmonton Frail Scale (EFS), Clinical Frailty Scale (CFS) and self-reported health change were assessed. Mortality was explored using Fine and Gray regression, and admissions by negative binomial regression.

Results

Over a median 678 (interquartile range 531–812) days, there were 111 deaths, and 1241 hospitalizations. Increasing frailty was associated with mortality on adjusted analyses for FP [subdistribution hazard ratio (SHR) 1.26, 95% confidence interval (CI) 1.05–1.53, P = .01], FI (SHR 1.21, 95% CI 1.09–1.35, P = .001) and CFS (SHR 1.32, 95% CI 1.11–1.58, P = .002), but not EFS (HR 1.08, 95% CI 0.99–1.18, P = .1). Health change interacted with frailty tools to modify association with mortality; only those who rated their health as the same or worse experienced increased mortality hazard associated with frailty by FP (P_interaction = .001 and 0.035, respectively), FI (P_interaction = .002 and .007, respectively) and CFS (P_interaction = .009 and 0.02, respectively). CFS was the only frailty tool associated with hospitalization (incidence rate ratio 1.12, 95% CI 1.02–1.23, P = .02).

Conclusions

We confirm the high burden of hospitalization and mortality associated with haemodialysis patients regardless of frailty tool utilized and introduce the discriminatory ability of self-reported health to identify the most at-risk frail individuals.

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