title: Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis.
abstract: BACKGROUND
  Frailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate-perceived frailty-is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship.
  
  
  METHODS
  146 adults undergoing hemodialysis were recruited from a single dialysis center in Baltimore, Maryland. Patient characteristics associated with perceived (reported by nephrologists, nurse practitioners (NPs), or patients) or measured frailty (using the Fried criteria) were identified using ordered logistic regression. The relationship between perceived and measured frailty was assessed using percent agreement, kappa statistic, Pearson's correlation coefficient, and prevalence of misclassification of frailty. Patient characteristics associated with misclassification were determined using Fisher's exact tests, t-tests, or median tests.
  
  
  RESULTS
  Older age (adjusted OR [aOR] = 1.36, 95%CI:1.11-1.68, P = 0.003 per 5-years older) and comorbidity (aOR = 1.49, 95%CI:1.27-1.75, P < 0.001 per additional comorbidity) were associated with greater likelihood of nephrologist-perceived frailty. Being non-African American was associated with greater likelihood of NP- (aOR = 5.51, 95%CI:3.21-9.48, P = 0.003) and patient- (aOR = 4.20, 95%CI:1.61-10.9, P = 0.003) perceived frailty. Percent agreement between perceived and measured frailty was poor (nephrologist, NP, and patient: 64.1%, 67.0%, and 55.5%). Among non-frail participants, 34.4%, 30.0%, and 31.6% were perceived as frail by a nephrologist, NP, or themselves. Older adults (P < 0.001) were more likely to be misclassified as frail by a nephrologist; women (P = 0.04) and non-African Americans (P = 0.02) were more likely to be misclassified by an NP. Neither age, sex, nor race was associated with patient misclassification.
  
  
  CONCLUSIONS
  Perceived frailty is an inadequate proxy for measured frailty among patients undergoing hemodialysis.
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. meg@jhmi.edu.|Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA. meg@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. meg@jhmi.edu.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. ngupta21@jhmi.edu.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. amassie1@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. amassie1@jhmi.edu.
authors.forename: Allan B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. mara@jhu.edu.|Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. mara@jhu.edu.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. alaw6@jhu.edu.|Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. alaw6@jhu.edu.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Law
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, USA. jacobl@ohsu.edu.
authors.forename: Reside Lorie
authors.initials: RL
authors.lastname: Jacob
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, Baltimore, MD, 21287, USA. lgimene1@jhmi.edu.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Gimenez
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. bjaar@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA. bjaar@jhmi.edu.|Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, Baltimore, MD, 21287, USA. bjaar@jhmi.edu.|Nephrology Center of Maryland, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21239, USA. bjaar@jhmi.edu.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA. jwalston@jhmi.edu.|Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 1A.62, Baltimore, MD, 21224, USA. jwalston@jhmi.edu.|Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Cir, Baltimore, MD, 21224, US. jwalston@jhmi.edu.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Walston
authors.affiliation: Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. dorry@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. dorry@jhmi.edu.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D012649:Self Concept