Nixon, Andrew C and Bampouras, Theodoros and Pendleton, Neil and Mitra, Sandip and Brady, Mark and Dhaygude, Ajay (2020) Frailty is Independently Associated with Worse Health-Related Quality of Life in Chronic Kidney Disease:A Secondary Analysis of the ‘Frailty Assessment in Chronic Kidney Disease’ Study. Clinical kidney journal, 13 (1). pp. 85-94. ISSN 2048-8505
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Abstract
BackgroundUnderstanding how frailty affects health-related quality of life (HRQOL) in those with chronic kidney disease (CKD) could assist in the development of management strategies to improve outcomes for this vulnerable patient group. This study aimed to evaluate the relationship between frailty and HRQOL in patients with CKD stage 4 and 5 (G4-5) and those established on haemodialysis (G5D). MethodsNinety participants with CKD G4-5D were recruited between December 2016 and December 2017. Frailty was assessed using the Frailty Phenotype, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), physical activity and self-perceived exhaustion. HRQOL was assessed using the RAND 36-Item Health Survey Version 1.0 (SF-36). ResultsNineteen (21%) patients were categorised as frail. Frailty, when adjusted for age, gender, dialysis-dependence and comorbidity, had a significant effect on five of the eight SF-36 domains: physical functioning, role limitations due to emotional problems, energy/fatigue, social functioning and pain. Regression modelling best explained the variation in the physical functioning domain (adj. R2 = 0.27, p <0.001), with frailty leading to a 26-point lower score. Exhaustion was the only Frailty Phenotype component that had a significant effect on scores across all SF-36 domains. ConclusionsFrailty is independently associated with worse HRQOL in patients with CKD G4-5D, with self-perceived exhaustion being the most significant Frailty Phenotype component contributing to HRQOL. Efforts should be made to identify frail patients with CKD so that management strategies can be offered that aim to improve morbidity, mortality and patient-reported outcomes, including HRQOL and fatigue.