title: Discriminative value of frailty screening instruments in end-stage renal disease.
abstract: BACKGROUND
  Numerous frailty screening instruments are available, but their applicability for identifying frailty in patients with end-stage renal disease (ESRD) is unknown. We aimed to investigate the diagnostic accuracy of three instruments used for frailty screening in an ESRD population.
  
  
  METHODS
  The study was conducted in 2013 in a teaching hospital in The Netherlands and included patients receiving haemodialysis, peritoneal dialysis and pre-dialysis care. We determined the sensitivity and specificity of three screening instruments: the Groningen Frailty Indicator (GFI), the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP) and the Veiligheidsmanagementsysteem (VMS), which is a safety management system for vulnerable elderly patients. The Frailty Index was the gold standard used.
  
  
  RESULTS
  The prevalence of frailty was 37% in a total of 95 participants with ESRD [mean age 65.2 years (SD 12.0), 57% male]. Frailty prevalence in participants ≥65 years of age and <65 years of age was 44% and 28%, respectively (P = 0.11). Sensitivity and specificity for frailty of the GFI were 89% and 57%, respectively; ISAR-HP 83% and 77%, respectively; and VMS 77% and 67%, respectively.
  
  
  CONCLUSIONS
  Although the GFI showed the highest sensitivity, it is not yet possible to propose a firm choice for one of these screening instruments or specific items due to the small scale of the study. Since there is a high prevalence of frailty in ESRD patients, translation and testing of the effectiveness of screening using the GFI in the prognostication and prevention of development or deterioration of frailty in this population should be the next step.
authors.affiliation: Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands; Department of Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
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: Department of Medicine, Division of Nephrology , Gelre Hospitals , Apeldoorn , The Netherlands.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Vogtlander
keywords: elderly; end-stage renal disease; frailty; frailty index; geriatric