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FRAIL scale as a screening tool and a predictor of mortality in non-dialysis dependent patients

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Abstract

Background

This study aimed to compare the diagnostic yield of the FRAIL scale with respect to the physical frailty phenotype measure and their association with mortality in non-dialysis-dependent patients.

Methods

In this prospective cohort study, non-dialysis dependent patients with chronic kidney disease (CKD) stages 3b–5 seen in the nephrology outpatient clinics of two university hospitals were included. The presence of frailty was evaluated by physical frailty phenotype measure and the FRAIL scale. Patients were evaluated for six months, and mortality was recorded. The Kappa test was used to evaluate the diagnostic properties between the methods, and logistic regression to test the association between frailty and mortality.

Results

One hundred fifty-three patients were evaluated; average age was 65 (56–70) years, 50.9% were women, and the all-cause mortality rate was 2.6%. Forty-six patients were classified as living with frailty according to the physical frailty phenotype while 36 patients were rated frail by the FRAIL scale. In adults < 60 years of age, the FRAIL scale showed good accuracy (84.9%) and specificity (93.2%) but had low sensitivity (41.3%) and moderate agreement (Kappa = 0.41; p < 0.001) compared to the definition of the physical frailty phenotype. The adjusted logistic regression model showed that the patients with frailty assessed by the FRAIL scale had a greater chance of mortality than the non-frail patients (OR: 6.8; CI95%:1.477–31.513; p = 0.014).

Conclusion

Physical frailty phenotype identifies more patients as having pre-frailty and frailty in non-dialysis dependent patients as compared to the FRAIL scale. However, the FRAIL scale is a simple bedside tool that can be useful for screening for frailty and whose results were associated with mortality.

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Data availability

The datasets collected and analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank all the patients and their families, who made this research possible.

Funding

This research was funded by the Goias Research Foundation- FAPEG, grant numbers 03/2022 (202310267000215) and CAPES scholarship.

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Authors and Affiliations

  1. Faculty of Nutrition, Federal University of Goiás – UFG, Street 227 Block 68 s/n, East University Sector, Goiânia, Goias, 74605-080, Brazil

    Hellen Christina Neves Rodrigues, Amanda Goulart de Oliveira Sousa, Vitória Rodrigues Morais Preto, Clara Sandra de Araújo Sugizaki, Ana Tereza Vaz de Souza Freitas, Maria do Rosário Gondim Peixoto & Nara Aline Costa

  2. Clinical Hospital, Federal University of Goiás – UFG, Goiânia, Brazil

    Camila Moura Batista Ferro

  3. Department of Internal Medicine, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Brazil

    Marcos Ferreira Minicucci & Paula Schmidt Azevedo

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  1. Hellen Christina Neves Rodrigues
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Contributions

HCNR: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Software, Validation, Visualization, Writing—original draft, Writing- review & editing. AGO: Investigation, Methodology, Visualization. VRMP: Investigation, Methodology. CMBF: Investigation, Methodology. CSAS: Conceptualization, Methodology. ATVSF: Formal analysis, Methodology, Writing–review. MFM: Data curation, Formal analysis, Validation, Writing—review & editing. PSA: Formal analysis, Validation, Writing—review & editing. MRGP: Data curation, Formal analysis, Methodology, Validation, Writing—review & editing. NAC: Conceptualization, Project administration, Supervision, Data curation, Formal analysis, Methodology, Validation, Writing—review & editing.

Corresponding author

Correspondence to Hellen Christina Neves Rodrigues.

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None.

Ethical approval

All procedures used in this study adhere to the tenets of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Federal University of Goias (n° 4.918.708) and of the two hospitals under opinions (n° 5.053.031 and n°. 5.112.682).

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Written informed consent was obtained from all patients or their relatives before their inclusion in the study.

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Rodrigues, H.C.N., Sousa, A.G.d., Preto, V.R.M. et al. FRAIL scale as a screening tool and a predictor of mortality in non-dialysis dependent patients. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01900-3

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