Frailty Assessment and Intervention in Chronic Kidney Disease

Abstract

Frailty is highly prevalent in chronic kidney disease (CKD) and associated with adverse health outcomes. Through recognising the importance of frailty for people with CKD, including developing our understanding of the patient perspective, this thesis aims to develop clinically feasible frailty assessment methods and targeted interventions to address unmet needs for people living with frailty and CKD. Studies presented in this thesis demonstrate that people living with frailty and CKD have an associated risk of worse health-related quality of life, greater symptom-burden and a distinctive symptom experience. These results highlight the need to identify people living with frailty and CKD and to offer a holistic assessment and targeted intervention that aim to improve important outcomes. The diagnostic accuracy of frailty screening methods was evaluated in people with advanced CKD. Results demonstrate that walking speed can be used to accurately screen for frailty. The Clinical Frailty Scale is a widely-accepted practical frailty screening tool; this research proved it to also be a useful measure in CKD. The EX-FRAIL CKD trial provided the necessary pilot data to inform the design of a randomised controlled trial evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. Progression to a definitive randomised controlled trial is possible provided recruitment and retention challenges are addressed. Preliminary evidence suggests that home-based exercise may be beneficial for people living with frailty and CKD. In conclusion, this thesis supports: (1) the use of validated frailty screening tools in nephrology care; and (2) future research that evaluates the effectiveness of holistic assessment and targeted interventions, including home-based exercise, in relation to important patient-reported outcomes for people living with frailty and CKD.

Date of Award	31 Aug 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Ajay Dhaygude (Supervisor) & Sandip Mitra (Supervisor)