Kidney Week

Abstract: SA-PO1123

Comparison of Claims-Based Definitions vs. Measured Frailty in Patients with CKD

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Hildebrand, Hailey Victoria, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Hailey Victoria Hildebrand, MD

• Harasemiw, Oksana, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Oksana Harasemiw, MSc

• Brar, Ranveer Singh, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Ranveer Singh Brar

• Komenda, Paul, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Paul Komenda, MD, MBA, FASN

• Rigatto, Claudio, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Claudio Rigatto, MD, MS, MSc

• Prasad, Bhanu, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada

Bhanu Prasad, MD

• Bohm, Clara, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Clara Bohm, MD, MPH

• Tangri, Navdeep, Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Navdeep Tangri, MD, PhD

Background

Frailty is common in patients with Chronic Kidney Disease (CKD), and those affected by both conditions are at increased risk of adverse outcomes including worsened disability, hospitalization, and death. Collecting data on frailty status as part of routine clinical care could enhance care by identifying patients at high risk of adverse events. Clinical assessment of frailty is time and resource intensive. Frailty definitions based on administrative data might provide a feasible and efficient alternative. The primary objective of this study was to compare agreements between administrative claims-based definitions for frailty versus objectively measured frailty in adults with advanced (Stage G4+), non-dialysis CKD.

Methods

The cohort consisted of Manitoba participants from the Canadian Frailty Observation and Interventions Trial (CanFIT). This multicentre cohort study followed 442 adults with an eGFR < 30mL/min/1.73 m² longitudinally. At each visit, an assessment was conducted to determine frailty status using the Fried Frailty Index, Short Physical Performance Battery, and healthcare providers impression. The CanFIT database was linked to several administrative health databases at the Manitoba Centre for Healthy Policy to calculate two claims-based frailty indices, the Segal Frailty Index and the Pre-operative Frailty Index, which have been previously validated in the non-CKD literature.

Results

Of participants included, the mean age was 65.8±13.9 years and 58.4% were male; 87.8% had hypertension, 61.3% dyslipidemia, and 57.5% diabetes. The prevalence of frailty varied from 18.1% to 69.5% depending on definition. Agreement between claims-based frailty indices and objective and subjective measures of frailty was low to modest (κ 0.08–0.31). Individuals considered frail, using both administrative or measured definitions, had an increased risk of all-cause mortality and hospitalization.

Conclusion

This study suggests that claims-based definitions of frailty developed in the general population are poor substitutes for identifying frailty in individuals with advanced, non-dialysis CKD. Efforts to integrate valid and efficient frailty assessments in clinical practice are needed to improve clinical decision making.