Clinical frailty scale, surprise question and 1-year mortality in older patients with advanced CKD

Demirhan, I.; Jongejan, M.; Oevelen, M. van; Kiriwenno, K.; Mooijaart, S.P.; Verhaar, M.C.; Bos, W.J.W.; Joosten, H.; Cnossen, T.T.; Buren, M. van; Abrahams, A.C.; DIALOGICA Study Grp

doi:doi:10.34067/KID.0000000936

Background: Frailty is common in older patients with advanced CKD and is associated with mortality. This study investigates whether the Clinical Frailty Scale (CFS) and Surprise Question (Would you be surprised if this patient died in the next 12 months?, SQ) are associated with 1-year mortality and whether combining risk assessments has benefits.

Methods: Patients >= 65 years with eGFR 20-10 ml/min per 1.73 m(2) were included from the ongoing prospective observational cohort study DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (first inclusion May 13th, 2020). Frailty was screened using the CFS, and the SQ was answered using clinical impression (gestalt). Patients were classified high risk with CFS score >= 5 and/or SQ answer no. Four subgroups were formed: high risk, CFS >= 5 & SQ no; high risk, CFS >= 5 only; high risk, SQ no only; and low risk, CFS <5 & SQ yes. Associations with 1-year mortality were explored using Kaplan-Meier curves...

Background: Frailty is common in older patients with advanced CKD and is associated with mortality. This study investigates whether the Clinical Frailty Scale (CFS) and Surprise Question (Would you be surprised if this patient died in the next 12 months?, SQ) are associated with 1-year mortality and whether combining risk assessments has benefits.

Methods: Patients >= 65 years with eGFR 20-10 ml/min per 1.73 m(2) were included from the ongoing prospective observational cohort study DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (first inclusion May 13th, 2020). Frailty was screened using the CFS, and the SQ was answered using clinical impression (gestalt). Patients were classified high risk with CFS score >= 5 and/or SQ answer no. Four subgroups were formed: high risk, CFS >= 5 & SQ no; high risk, CFS >= 5 only; high risk, SQ no only; and low risk, CFS <5 & SQ yes. Associations with 1-year mortality were explored using Kaplan-Meier curves and adjusted Cox proportional hazards models.

Results: Overall, 589 patients were included (male sex 70%, mean age 77 +/- 6 years, mean eGFR 15 +/- 3 ml/min per 1.73 m(2)). CFS score >= 5 was found in 125 patients (21%) and 112 patients (19%) had SQ answer no. Both CFS score >= 5 (adjusted hazard ratio [HR], 3.09; 95% CI, 1.75 to 5.54) and SQ answer no (adjusted HR, 1.96; 95% CI, 1.09 to 3.52) were associated with higher mortality risk. Subgroup high risk, CFS >= 5 and SQ no had the highest mortality risk (adjusted HR, 3.37; 95% CI, 1.65 to 6.91).

Conclusions: Both CFS score >= 5 and SQ answer no are associated with higher 1-year mortality risk in older patients with advanced CKD. The strongest association with mortality was found by combining both assessments, when both indicate high risk. These findings may help older patients and nephrologists make better informed treatment decisions and initiate timely advance care planning conversations.

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Clinical frailty scale, surprise question and 1-year mortality in older patients with advanced CKD