title: Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education.
abstract: BACKGROUND
  The incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education.
  
  
  METHODS
  We performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015.
  
  
  RESULTS
  The CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death.
  
  
  CONCLUSIONS
  A relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease.
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Pugh
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Justine
authors.initials: J
authors.lastname: Aggett
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Annwen
authors.initials: A
authors.lastname: Goodland
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Prichard
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Nerys
authors.initials: N
authors.lastname: Thomas
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Kieron
authors.initials: K
authors.lastname: Donovan
authors.affiliation: Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Roberts
keywords: chronic kidney disease; comorbidity; dialysis; frailty; outcomes