Lamberink Kyra, Vermeeren Yolande M, Moes Arthur D, Mulderij Jeanette, Rootjes Paul A, Zomer Tizza P
Department of Internal Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.
Clin Kidney J. 2024 May 2;17(7):sfae132. doi: 10.1093/ckj/sfae132. eCollection 2024 Jul.
The frailty index (FI) is commonly used to estimate frailty in end-stage kidney disease (ESKD) patients. The Clinical Frailty Scale (CFS) is a less time-consuming alternative. We aimed to determine the test performance of the CFS for pre-dialysis and dialysis patients and patients receiving conservative therapy from the Dialysis Centre Apeldoorn.
In this cross-sectional study, haemodialysis, peritoneal dialysis, pre-dialysis patients and patients receiving conservative therapy from the Dialysis Centre Apeldoorn were included and subjected to frailty assessment. Nephrologists not familiar with the CFS completed the frailty score after medical consultation. The sensitivity, specificity and area under the curve (AUC) of the CFS were determined. The FI was used as the gold standard.
Included were 144 patients, of whom 60 (41.7%) were considered frail according to the FI. The mean age was 67.4 ± 13.5 years and 56 (38.9%) were female. The cut-off point of the CFS for 'vulnerable' (CFS ≥4) had a sensitivity of 63.3%, a specificity of 81.0% and an AUC of 0.72. The cut-off point of the CFS for 'frail' (CFS ≥5) had a sensitivity of 50.0%, a specificity of 91.7% and an AUC of 0.71.
The CFS is a quick and easy-to-use tool for the determination of frailty in ESKD patients with a high prevalence of frailty. Nevertheless, the sensitivity of the CFS in the present study was considered too low to implement into daily clinical practice. The sensitivity might be increased by training nephrologists in the use of the CFS.
衰弱指数（FI）常用于评估终末期肾病（ESKD）患者的衰弱情况。临床衰弱量表（CFS）是一种耗时较短的替代方法。我们旨在确定CFS在阿珀尔多伦透析中心的透析前患者、透析患者及接受保守治疗患者中的测试性能。
在这项横断面研究中，纳入了来自阿珀尔多伦透析中心的血液透析、腹膜透析、透析前患者及接受保守治疗的患者，并对其进行衰弱评估。不熟悉CFS的肾病科医生在会诊后完成衰弱评分。确定了CFS的敏感性、特异性和曲线下面积（AUC）。FI被用作金标准。
共纳入144例患者，其中根据FI评估有60例（41.7%）被认为衰弱。平均年龄为67.4±13.5岁，女性56例（38.9%）。CFS中“易损”（CFS≥4）的截断点敏感性为63.3%，特异性为81.0%，AUC为0.72。CFS中“衰弱”（CFS≥5）的截断点敏感性为50.0%，特异性为91.7%，AUC为0.71。
CFS是一种快速且易于使用的工具，可用于确定衰弱患病率较高的ESKD患者的衰弱情况。然而，本研究中CFS的敏感性被认为过低，无法应用于日常临床实践。通过培训肾病科医生使用CFS，敏感性可能会提高。
