title: High prevalence of frailty in end-stage renal disease.
abstract: OBJECTIVE
  Prognosis of the increasing number of elderly patients with end-stage renal disease (ESRD) is poor with high risk of functional decline and mortality. Frailty seems to be a good predictor for those patients that will not benefit from dialysis. Varying prevalences between populations are probably related to the instrument used. The aim of this study was to measure the prevalence of frailty among ESRD patients with two different validated instruments.
  
  
  METHODS
  This cross-sectional study was conducted among patients, aged ≥18 years, receiving hemodialysis, peritoneal dialysis and pre-dialysis care between September 2013 and December 2013 in a single dialysis center in Apeldoorn, the Netherlands. Frailty was measured with the frailty index (FI) and frailty phenotype (FP).
  
  
  RESULTS
  Prevalence of frailty by the FI was 36.8 % among 95 participants with ESRD (age: 65.2 years, SD ± 12.0). Frailty prevalence among participants aged ≥65 and <65 years was 43.6 and 27.5 %, respectively. Female sex [odds ratio (OR) 3.3, 95 % confidence interval (CI) 1.3-8.0] and a Charlson comorbidity index score of ≥5 (OR 2.6, 95 % CI 1.0-6.6) were associated with frailty. The FI identified different but overlapping participants as frail compared with the FP; 62.5 % of frail participants according to FI were also frail according to the FP.
  
  
  CONCLUSIONS
  Prevalence of frailty among young and elderly ESRD patients is high; being female and having more comorbidity was associated with frailty. Use of a broader definition of frailty, like the FI, gives a higher estimation of prevalence among ESRD patients compared with a physical frailty assessment.
authors.affiliation: Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: Drost
authors.affiliation: Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: Annette
authors.initials: A
authors.lastname: Kalf
authors.affiliation: Division of Nephrology, Department of Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: Nils
authors.initials: N
authors.lastname: Vogtlander
authors.affiliation: Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands. b.van.munster@gelre.nl.|Department of Medicine, University Medical Center Groningen, Groningen, The Netherlands. b.van.munster@gelre.nl.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Elderly; End-stage renal disease; Frailty; Frailty index; Frailty phenotype