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Frailty among Older Patients with Baseline Advanced Non-Dialysis Chronic Kidney Disease

Maria Eugenia Portilla Franco*, Fernando Tornero Molina, Jose Antonio Herrero Calvo, Pedro Gil Gregorio

Objective: Given the important association between frailty and Chronic Kidney Disease (CKD), we assessed the prognostic value of the Frailty Phenotype (FP) in elderly patients with advanced CKD and compared the ability of two established frailty tools to predict mortality.

Methods: Observational, prospective study with two years of follow-up. Spanish patients ≥ 65 years from the Nephrology clinic at San Carlos Hospital, with an eGFR<20 mL/min/1.73 m², and without renal replacement therapy. All patients received functional, cognitive and nutritional assessments. Frailty was measured using established FP cut-off. Regression models were conducted to determine whether frailty was associated with greater mortality, hospital admission, and dialysis initiation. The frailty assessments included the Short Physical Performance Battery (SPPB) and gait speed.

Results: One hundred individuals (62% male; mean age 78.8 ± 7.1 years) were assessed and showed a prevalence of frailty of 44.7%. The mean follow-up was 2.1 ± 0.2 years, during which 34% started dialysis and 24% died. Frail patients had an increased adjusted risk of death (HR 5.4; 95% CI:1.859-15.866) and hospital admission (OR 3.4; 95% CI:1.247-9.534). SPPB had better predictive ability in estimating the risk of death at two years, similar to that obtained by the FP.

Conclusion: Our results support the prognostic value of the FP in the assessment of advanced CKD patients, the use of the SPPB tool in clinical practice for risk stratification of patients and the possible benefit from establishing effective interventions aimed at improving or reversing the frailty condition, thus improving the quality of life for this special population.