让临床医生和患者参与评估和改进终末期肾病成人患者的衰弱测量。
Engaging clinicians and patients to assess and improve frailty measurement in adults with end stage renal disease.
作者信息
Van Pilsum Rasmussen Sarah, Konel Jonathan, Warsame Fatima, Ying Hao, Buta Brian, Haugen Christine, King Elizabeth, DiBrito Sandra, Varadhan Ravi, Rodríguez-Mañas Leocadio, Walston Jeremy D, Segev Dorry L, McAdams-DeMarco Mara A
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
出版信息
BMC Nephrol. 2018 Jan 12;19(1):8. doi: 10.1186/s12882-017-0806-0.
BACKGROUND
The Fried frailty phenotype, a measure of physiologic reserve defined by 5 components (exhaustion, unintentional weight loss, low physical activity, slow walking speed, and poor grip strength), is associated with poor outcomes among ESRD patients. However, these 5 components may not fully capture physiologic reserve in this population. We aimed to ascertain opinions of ESRD clinicians and patients about the usefulness of the Fried frailty phenotype and interventions to improve frailty in ESRD patients, and to identify novel components to further characterize frailty in ESRD.
METHODS
Clinicians who treat adults with ESRD completed a 2-round Delphi study (n = 41 and n = 36, respectively; response rate = 87%). ESRD patients completed a survey at transplant evaluation (n = 460; response rate = 81%). We compared clinician and patient opinions on the constituent components of frailty.
RESULTS
Clinicians were more likely than patients to say that ESRD makes patients frail (97.6% vs. 60.2%). There was consensus among clinicians that exhaustion, low physical activity, slow walking speed, and poor grip strength characterize frailty in ESRD patients; however, 29% of clinicians thought weight loss was not relevant. Patients were less likely than clinicians to say that the 5 Fried frailty components were relevant. Clinicians identified 10 new ESRD-specific potential components including falls (64%), physical decline (61%), and cognitive impairment (39%). Clinicians (83%) and patients (80%) agreed that intradialytic foot-peddlers might make ESRD patients less frail.
CONCLUSIONS
There was consensus among clinicians and moderate consensus among patients that frailty is more common in ESRD. Weight loss was not seen as relevant, but new components were identified. These findings are first steps in refining the frailty phenotype and identifying interventions to improve physiologic reserve specific to ESRD patients.
背景
弗里德衰弱表型是一种由五个组成部分（疲惫、非故意体重减轻、低体力活动、行走速度缓慢和握力差）定义的生理储备指标，与终末期肾病（ESRD）患者的不良预后相关。然而，这五个组成部分可能无法完全反映该人群的生理储备情况。我们旨在确定ESRD临床医生和患者对弗里德衰弱表型的有用性以及改善ESRD患者衰弱状况的干预措施的看法，并识别新的组成部分以进一步描述ESRD患者的衰弱特征。
方法
治疗成年ESRD患者的临床医生完成了两轮德尔菲研究（第一轮n = 41，第二轮n = 36；回复率 = 87%）。ESRD患者在移植评估时完成了一项调查（n = 460；回复率 = 81%）。我们比较了临床医生和患者对衰弱组成部分的看法。
结果
临床医生比患者更倾向于认为ESRD会使患者变得衰弱（97.6%对60.2%）。临床医生一致认为疲惫、低体力活动、行走速度缓慢和握力差是ESRD患者衰弱的特征；然而，29%的临床医生认为体重减轻与衰弱无关。患者比临床医生更不太可能认为弗里德衰弱的五个组成部分与衰弱相关。临床医生识别出10个新的ESRD特异性潜在组成部分，包括跌倒（64%）、身体机能下降（61%）和认知障碍（39%）。临床医生（83%）和患者（80%）一致认为透析期间使用脚踏装置可能会使ESRD患者的衰弱程度减轻。
结论
临床医生之间达成了共识，患者之间也有适度共识，即衰弱在ESRD患者中更为常见。体重减轻未被视为与衰弱相关，但识别出了新的组成部分。这些发现是完善衰弱表型和确定改善ESRD患者特定生理储备的干预措施的第一步。
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