Clinical Frailty Scale, Surprise Question and 1-year Mortality in Older Patients with Advanced CKD

Area of Science:

• Nephrology
• Geriatrics
• Public Health

Background:

• Frailty is prevalent in advanced chronic kidney disease (CKD).
• Frailty is linked to increased mortality in older adults with CKD.
• Current risk assessment tools for mortality in CKD require further investigation.

Purpose of the Study:

• To evaluate the association of the Clinical Frailty Scale (CFS) and the Surprise Question (SQ) with one-year mortality in older patients with advanced CKD.
• To determine if combining CFS and SQ improves mortality risk prediction.
• To inform treatment decisions and advance care planning in this population.

Main Methods:

• Prospective observational cohort study (DIALOGICA) including patients aged ≥65 with eGFR 10-20 mL/min/1.73m2.
• Frailty assessed using CFS (score ≥5 indicating high risk) and SQ (answer 'no' indicating high risk).
• Patients categorized into four risk subgroups; one-year mortality analyzed using Kaplan-Meier curves and adjusted Cox models.

Main Results:

• 589 patients included (mean age 77 years, 70% male, mean eGFR 15 mL/min/1.73m2).
• CFS score ≥5 (21%) and SQ 'no' (19%) were independently associated with higher one-year mortality.
• The highest mortality risk was observed in patients with both CFS ≥5 and SQ 'no' (adjusted HR 3.37).

Conclusions:

• Both CFS and SQ are significant predictors of one-year mortality in older adults with advanced CKD.
• Combining CFS and SQ provides a more robust assessment of mortality risk.
• These validated risk assessments can aid clinicians and patients in making informed decisions regarding treatment and care planning.