Functional predictors of frailty and kidney disease burden in patients with end-stage renal disease receiving dialysis

Background: Frailty is a complex syndrome involving failure of multiple body systems leading to adverse patient outcomes. In patients who receive dialysis, the prevalence of frailty can be as high as 73%, even among younger older adults, with frailty increasing as kidney disease progresses. Despite the high prevalence of frailty, systematic identification of frailty in patients with chronic kidney disease and end-stage renal disease is not standard practice. There is limited research on optimal strategies available to perform these assessments. The literature shows a link between physical well-being and the burden of kidney disease among patients with end-stage renal disease. The goal of this study was to determine functional predictors of frailty and kidney disease burden among patients with chronic kidney disease receiving dialysis. Methods: Twenty-eight patients receiving dialysis at the Wise Health System dialysis center in Decatur, Texas consented to participate in the study. The study analyzed number of falls in the past year, Timed Up and Go time, and 30-second sit to stand repetitions as predictors of (a) frailty score and (b) Kidney Disease Quality of Life burden of kidney disease subscale score. For each research question, linear regression analysis was performed. Results: The overall model predicting frailty score from the predictor variables was significant and accounted for 78.4% of the variance. Timed Up and Go time and 30-second sit to stand repetitions were significant predictors of frailty score. The overall model predicting burden of kidney disease was significant when number of falls in the past year was analyzed independently, accounting for 21.7% of the variance. Discussion and Conclusion: The results of this study provide evidence for the use of Timed Up and Go time and 30-second sit to stand repetitions as assessment tools predicting the physical domain of frailty. The number of falls in the past year contributes to the psychological and social domains of frailty. Individuals with end-stage renal disease receiving dialysis are underserved in physical therapy practice. Preventative strategies are essential as a one-point increase in frailty score correlates to an 87% increase in mortality in this vulnerable population.