Frailty is associated with technique failure and mortality in prevalent home dialysis patients
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Dialysis, while life preserving, is associated with poor quality of life and high healthcare costs. Home dialysis modalities offer equivalent survival to in-center dialysis but have quality of life advantages and reduced healthcare costs; however, nearly half of home dialysis patients experience technique failure within two years and transition to in-center dialysis. Frailty has been associated with poor outcomes in kidney disease, but not study has evaluated its association with the outcomes of technique failure and mortality in those with kidney failure being treated with home dialysis. Furthermore, little research has been done in evaluating agreement between different constructs of frailty. In our prospective single center cohort study, we evaluated 109 peritoneal dialysis and home dialysis patients for frailty using the modified Fried criteria, the short physical performance batter (SPPB), and physician and nurse impressions. Over the course of the study 39 patients had technique failure and 38 died. Agreement between objective tools (modified Fried and SPPB) was found to be moderate (Cohen’s kappa=0.55) and agreement between subjective tools (physician and nurse impressions) to be good (kappa=0.63). All assessment tools were associated with a two-fold increase in risk of technique failure or death independent of age, sex, and common comorbid conditions except for the SPPB with hazard ratios of 2.42-2.53. Frailty is associated with adverse outcomes in home dialysis and is easy to assess at bedside. External validation followed by clinical implementation of frailty assessment as part of the home dialysis evaluation should be considered as the next steps.