Timing Matters: Longitudinal Changes in Frailty Among Elderly Patients with End-Stage Renal Disease
DOI:
https://doi.org/10.52340/GBMN.2026.01.01.196Keywords:
Chronic kidney disease, Conservative management, Dialysis, Elderly, End-stage renal disease, Frailty, Mortality prediction, Prognostic scoreAbstract
Background: Frailty is often first assessed near the dialysis decision point, when acute illness, uremia, and metabolic instability may influence Clinical Frailty Scale (CFS) scores. Attrition through death may further alter the frailty profile observed over time, making assessment timing important for interpretation.
Objectives: To describe longitudinal changes and category transitions in CFS scores and to explore their relationship with treatment trajectory, mortality, and follow-up completeness.
Methods: This secondary, exploratory longitudinal analysis used data from a prospective single-center cohort of 64 patients aged 65 years or older with end-stage renal disease (ESRD) at the dialysis decision point, baseline CFS ≥5, and Charlson Comorbidity Index ≥3. Treatment trajectories were stable comprehensive conservative care (CCC; n=19), stable dialysis (n=35), and treatment transition (n=10). CFS was assessed at baseline and during the 3-, 6-, and 12-month intervals. Paired changes from baseline were estimated using available observations without imputation. Baseline CFS and 12-month mortality were examined using univariable logistic regression.
Results: CFS observations were available for 64, 61, 33, and 27 patients at baseline and during the 3-, 6-, and 12-month intervals, respectively; corresponding median scores were 7, 8, 6, and 6. The CCC group showed a modest increase from baseline to the first 3-month interval (+0.44; P=0.028). No baseline-to-6-month within-group change was statistically significant. From baseline to 12 months, CFS decreased in the stable dialysis group (−1.23; P=0.047), while other groups showed no significant change. After the first 3-month interval, most participants with paired observations remained in the same CFS category. Thirty patients (46.9%) died, including 20 within 3 months, and only 27 participants had complete CFS follow-up. Participants alive and under follow-up at 12 months were younger and had lower baseline CFS than those who died.
Conclusions: CFS values in older, frail patients with ESRD varied according to assessment time, while death and incomplete follow-up changed the composition of the observed cohort. A CFS score obtained at the dialysis decision point should therefore be interpreted in its clinical context. Recording assessment conditions and repeating CFS after stabilization may provide a more complete view of patient trajectory. These exploratory findings require confirmation in larger longitudinal studies that account for death and informative dropout.
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