Puri Alisha, Lloyd Anita M, Bello Aminu K, Tonelli Marcello, Campbell Sandra M, Tennankore Karthik, Davison Sara N, Thompson Stephanie
Meharry Medical College, Nashville, TN.
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Kidney Med. 2025 Jan 4;7(3):100960. doi: 10.1016/j.xkme.2024.100960. eCollection 2025 Mar.
RATIONALE & OBJECTIVE: Frailty represents a loss of physiologic reserve across multiple biological systems, confers a higher risk of adverse health outcomes, and is highly prevalent among people with chronic kidney disease (CKD). We evaluated the measurement properties of frailty tools used in CKD and summarized the association of frailty with death and hospitalization.
Systematic review and meta-analysis.
SETTING & STUDY POPULATIONS: Studies assessing multidimensional frailty tools in adults at any stage of CKD and evaluating a measurement property of interest as per the Consensus-based Standards for the Selection of Health Measurement Instruments taxonomy.
Observational studies and randomized trials.
Risk and precision measurements; measurement properties.
The Comprehensive Geriatric Assessment was the clinical standard for frailty identification. We pooled data using random effects models or summarized with narrative synthesis when data were too heterogenous to pool.
We included 105 studies with data for at least one of the following: discriminative (n = 84; 80%), convergent (n = 20; 19%), and criterion validity (n = 2; 2%); responsiveness (n = 9; 9%) and reliability (n = 1; 0.1%). For the Fried Frailty Phenotype (FFP), the pooled adjusted HR (aHR) for mortality was 2.01 (95% confidence intervals [CI], 1.35-2.98; = 0.001; = 58%) and 1.89 (95% CI, 1.25-2.85; = 0.002; = 0%) for hospitalization in kidney failure (KF) populations. The pooled aHR for the Clinical Frailty Scale for mortality in pre-frail versus non-frail was 1.75 (95% CI, 1.17-2.60; = 26%) and 2.20 (95% CI, 1.00-4.80; = 66%) in frail versus non-frail. The Fatigue, Resistance, Ambulation, Illness, and Loss of weight scale showed consistent discriminative validity for higher mortality in non-dialysis CKD. The modified FFP (self-reported) showed acceptable discriminative validity and agreement with the FFP in patients with KF. In CKD and KF populations, agreement between clinicians' subjective impression of frailty and frailty tools was low.
Few studies compared the accuracy of frailty tools to the Comprehensive Geriatric Assessment. Only 1 study reported reliability. Studies were of overall low-moderate quality.
The FFP and Clinical Frailty Scale showed acceptable discriminant validity for clinical outcomes, and the modified FFP is an alternative tool to use if direct measurements are not feasible. The evidence does not support the use of clinicians' subjective impression to identify frailty.
衰弱代表多个生物系统生理储备的丧失，会增加不良健康结局的风险，且在慢性肾脏病（CKD）患者中非常普遍。我们评估了CKD中使用的衰弱评估工具的测量特性，并总结了衰弱与死亡和住院的关联。
系统评价和荟萃分析。
评估CKD任何阶段成人多维衰弱评估工具，并根据基于共识的健康测量工具选择标准分类法评估感兴趣的测量特性的研究。
观察性研究和随机试验。
风险和精度测量；测量特性。
综合老年评估是衰弱识别的临床标准。我们使用随机效应模型汇总数据，或在数据异质性过高无法汇总时采用叙述性综合进行总结。
我们纳入了105项研究，这些研究至少提供了以下一项数据：区分性（n = 84；80%）、收敛性（n = 20；19%）和标准效度（n = 2；2%）；反应性（n = 9；9%）和可靠性（n = 1；0.1%）。对于Fried衰弱表型（FFP），在肾衰竭（KF）人群中，死亡的合并调整后风险比（aHR）为2.01（95%置信区间[CI]，1.35 - 2.98；P = 0.001；I² = 58%），住院的aHR为1.89（95%CI，1.25 - 2.85；P = 0.002；I² = 0%）。在虚弱与非虚弱的比较中，临床衰弱量表在虚弱前期与非虚弱者中死亡的合并aHR为1.75（95%CI，1.17 - 2.60；I² = 26%），在虚弱与非虚弱者中为2.20（95%CI，1.00 - 4.80；I² = 66%）。疲劳、抵抗力、活动能力、疾病和体重减轻量表在非透析CKD患者中显示出对较高死亡率的一致区分效度。改良FFP（自我报告）在KF患者中显示出可接受的区分效度且与FFP一致。在CKD和KF人群中，临床医生对衰弱的主观印象与衰弱评估工具之间的一致性较低。
很少有研究将衰弱评估工具的准确性与综合老年评估进行比较。只有1项研究报告了可靠性。研究总体质量为低到中等。
FFP和临床衰弱量表对临床结局显示出可接受的区分效度，并且如果直接测量不可行，改良FFP是一种可替代的工具。现有证据不支持使用临床医生的主观印象来识别衰弱。
