Use of frailty assessment instruments in nephrology populations: a scoping review

Abstract

Abstract Background Frailty is a clinical syndrome of accelerated aging associated with adverse outcomes. Frailty is prevalent among patients with chronic kidney disease but is infrequently assessed in clinical settings, due to lack of consensus regarding frailty definitions and diagnostic tools. This study aimed to review the practice of frailty assessment in nephrology populations and evaluate the context and timing of frailty assessment. Methods The search included published reports of frailty assessment in patients with chronic kidney disease, undergoing dialysis or in receipt of a kidney transplant, published between January 2000 and November 2021. Medline, CINAHL, Embase, PsychINFO, PubMed and Cochrane Library databases were examined. A total of 164 articles were included for review. Results We found that studies were most frequently set within developed nations and adopted an observational study design, with paucity of interventional research. Studies favoured assessment of participants with chronic kidney disease (CKD) and transplant candidates. A total of 40 different frailty metrics were used. The most frequently utilised tool was the Fried Frailty Phenotype. Frailty prevalence varied across populations and research settings from 2.8% among participants with CKD to 82% among patients undergoing haemodialysis. Frailty was infrequently examined in conservatively managed populations. We verified that frailty predicts higher rates of adverse patient outcomes. There is sufficient literature to justify future meta-analyses. Conclusions There is increasing recognition of frailty in nephrology populations and the value of assessment in informing prognostication and decision-making during transitions in care. The Fried Frailty Phenotype is frequently utilised and offers comparison of frailty prevalence and outcomes over different research settings, as well as offering the opportunity to define a pre-frail state. Further research examining frailty in culturally and linguistically diverse populations is required. Future work should focus on interventional strategies exploring frailty rehabilitation.