Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease

doi:10.3877/cma.j.issn.2095-3216.2023.04.010

Abstract

Abstract:

Frailty is a clinical syndrome characterized by a decrease in the physical reserve of the body, and increases in individual external dependence and susceptibility to disease. Frailty has a high prevalence in patients with chronic kidney disease (CKD) and has been proven to be associated with a variety of adverse outcomes. Currently, there are up to 67 types of screening/assessment tools for frailty in the world, while there is no consensus on the best screening/assessment method for frailty in CKD patients. This review provided a comparative analysis of current screening/assessment tools for frailty in CKD patients.

Key words: Chronic kidney disease, Frailty, Assessment tool, Frailty phenotype, Frailty scale

Changyuan Yang, Xitao Ling, Jiamei Qiu, Ruolan Duan, Qin Li, Yujie Lin, Xindong Qin, Haijing Hou, Fuhua Lu, Guobin Su. Progress of research on screening/assessment tools for frailty in patients with chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 229-233.

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References 50

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衰弱患病率及其与不良结局的关系	非透析患者	透析患者	肾移植患者
衰弱患病率	7%~42.6%^[5]	14%~73%^[5]	13.3%~25.1%^[7]
衰弱与不良结局的关系	肾功能↓^[8]	生活质量↓^[12]	移植成功率↓^[16]
	生活质量↓^[9]	跌倒风险↑^[13]	住院事件↑^[17]
	住院事件↑^[10]	住院风险↑^[14]	死亡风险↑^[18]
	死亡风险↑^[11]	死亡风险↑^[14,15]	心血管事件↑^[17]

衰弱患病率及其与不良结局的关系	非透析患者	透析患者	肾移植患者
衰弱患病率	7%~42.6%^[5]	14%~73%^[5]	13.3%~25.1%^[7]
衰弱与不良结局的关系	肾功能↓^[8]	生活质量↓^[12]	移植成功率↓^[16]
	生活质量↓^[9]	跌倒风险↑^[13]	住院事件↑^[17]
	住院事件↑^[10]	住院风险↑^[14]	死亡风险↑^[18]
	死亡风险↑^[11]	死亡风险↑^[14,15]	心血管事件↑^[17]

评估工具	构成	优势	局限	评分与分级	研究人群
衰弱表型	5项条目：低体力活动水平、行走缓慢、握力下降、疲惫感和非自主体重下降。	客观+主观评估高敏感性 CKD中应用最为广泛	部分条目不易收集包含残疾的评估，但未包含合并症	0~5分；0＝强健，1~2＝衰弱前期，≥3＝衰弱	非透析CKD^[8,25] HD^[26] 肾移植^[16,17]
MFP量表	4项条目：低体力活动水平、疲惫感、身体机能和精力分量表	数据易于收集，所有条目均可从SF-36量表中获取	主观评估特异性较低未包含合并症和残疾的评估	同衰弱表型	HD和腹透^[27] HD^[28,29]
衰弱指数	基于缺陷累积理论，通常包括40-70项缺陷。涵盖合并症、疾病症状和自我报告的残疾等方面	半定量工具高特异性评估全面，对不良结局的预测优于衰弱表型包含合并症和残疾的评估	较为繁琐、耗时	0~1分；≤0.12＝无衰弱，0.12~0.25＝衰弱前期，≥0.2＝衰弱	非透析CKD^[30,31,32]
临床衰弱量表	9级量表：涵盖行动能力、能量消耗、体力活动和功能等方面	图文并茂，易于理解对衰弱程度进行递进式分层	主观评估包含残疾的评估，但未包含合并症	1~9分；非常健康~非常严重的衰弱	非透析CKD^[33] HD^[15,32]
FRAIL量表	5项条目：疲乏、耐力下降、自由活动下降、合并症和体重下降	简便易行，一般可在1分钟内完成评估包含合并症与残疾的评估	主观评估	0~5分；0＝健康状态，1~2＝衰弱前期，≥3＝衰弱	HD^[34] 非透析CKD和 HD^[35] 肾移植^[17]
埃德蒙顿衰弱量表	9项条目：认知水平、健康状况、功能依赖、社会支持、用药情况、营养状况、情绪、自控力和活动能力	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	部分条目不易收集	0~17分；≥7＝衰弱	HD^[34,36,37]
Groningen衰弱量表	15项条目：涵盖行动能力、身体健康、视力、听力、营养、认知功能、合并症和社会心理等八个方面	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	较为繁琐、耗时低敏感性	0~15分；≥4＝衰弱	非透析CKD^[38] 紧急透析^[39] HD^[34]

评估工具	构成	优势	局限	评分与分级	研究人群
衰弱表型	5项条目：低体力活动水平、行走缓慢、握力下降、疲惫感和非自主体重下降。	客观+主观评估高敏感性 CKD中应用最为广泛	部分条目不易收集包含残疾的评估，但未包含合并症	0~5分；0＝强健，1~2＝衰弱前期，≥3＝衰弱	非透析CKD^[8,25] HD^[26] 肾移植^[16,17]
MFP量表	4项条目：低体力活动水平、疲惫感、身体机能和精力分量表	数据易于收集，所有条目均可从SF-36量表中获取	主观评估特异性较低未包含合并症和残疾的评估	同衰弱表型	HD和腹透^[27] HD^[28,29]
衰弱指数	基于缺陷累积理论，通常包括40-70项缺陷。涵盖合并症、疾病症状和自我报告的残疾等方面	半定量工具高特异性评估全面，对不良结局的预测优于衰弱表型包含合并症和残疾的评估	较为繁琐、耗时	0~1分；≤0.12＝无衰弱，0.12~0.25＝衰弱前期，≥0.2＝衰弱	非透析CKD^[30,31,32]
临床衰弱量表	9级量表：涵盖行动能力、能量消耗、体力活动和功能等方面	图文并茂，易于理解对衰弱程度进行递进式分层	主观评估包含残疾的评估，但未包含合并症	1~9分；非常健康~非常严重的衰弱	非透析CKD^[33] HD^[15,32]
FRAIL量表	5项条目：疲乏、耐力下降、自由活动下降、合并症和体重下降	简便易行，一般可在1分钟内完成评估包含合并症与残疾的评估	主观评估	0~5分；0＝健康状态，1~2＝衰弱前期，≥3＝衰弱	HD^[34] 非透析CKD和 HD^[35] 肾移植^[17]
埃德蒙顿衰弱量表	9项条目：认知水平、健康状况、功能依赖、社会支持、用药情况、营养状况、情绪、自控力和活动能力	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	部分条目不易收集	0~17分；≥7＝衰弱	HD^[34,36,37]
Groningen衰弱量表	15项条目：涵盖行动能力、身体健康、视力、听力、营养、认知功能、合并症和社会心理等八个方面	客观+主观评估包含认知和营养的评估包含合并症与残疾的评估	较为繁琐、耗时低敏感性	0~15分；≥4＝衰弱	非透析CKD^[38] 紧急透析^[39] HD^[34]

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