Author(s): Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, , Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, , Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, , Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J,
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Abstract BACKGROUND: A well-accepted definition of frailty includes measurements of physical performance, which may limit its clinical utility. STUDY DESIGN: In a cross-sectional study, we compared prevalence and patient characteristics based on a frailty definition that uses self-reported function to the classic performance-based definition and developed a modified self-report-based definition. SETTING & PARTICIPANTS: Prevalent adult patients receiving hemodialysis in 14 centers around San Francisco and Atlanta in 2009-2011. INDEX TESTS: Self-report-based frailty definition in which a score lower than 75 on the Physical Function scale of the 36-Item Short Form Health Survey (SF-36) was substituted for gait speed and grip strength in the classic definition; modified self-report definition with optimized Physical Function score cutoff points derived in a development (one-half) cohort and validated in the other half. REFERENCE TEST: Performance-based frailty defined as 3 of the following: weight loss, weakness, exhaustion, low physical activity, and slow gait speed. RESULTS: 387 (53\%) patients were frail based on self-reported function, of whom 209 (29\% of the cohort) met the performance-based definition. Only 23 (3\%) met the performance-based definition of frailty only. The self-report definition had 90\% sensitivity, 64\% specificity, 54\% positive predictive value, 93\% negative predictive value, and 72.5\% overall accuracy. Intracellular water per kilogram of body weight and serum albumin, prealbumin, and creatinine levels were highest among nonfrail individuals, intermediate among those who were frail by self-report, and lowest among those who also were frail by performance. Age, percentage of body fat, and C-reactive protein level followed an opposite pattern. The modified self-report definition had better accuracy (84\%; 95\% CI, 79\%-89\%) and superior specificity (88\%) and positive predictive value (67\%). LIMITATIONS: Our study did not address prediction of outcomes. CONCLUSIONS: Patients who meet the self-report-based but not the performance-based definition of frailty may represent an intermediate phenotype. A modified self-report definition can improve the accuracy of a questionnaire-based method of defining frailty. Published by Elsevier Inc.
This article was published in Am J Kidney Dis
and referenced in International Journal of Swarm Intelligence and Evolutionary Computation