Dr LIMY WONG1,2, Professor LAWRENCE P MCMAHON1,2
1Eastern Health, Box Hill, Australia, 2Monash University Eastern Health Clinical School, Box Hill, Australia
Biography:
Dr Limy Wong is a Nephrologist and Postdoctoral Fellow at Eastern Health. She graduated with First Class Honours in Medicine from the Royal College of Surgeons in Ireland and completed Nephrology specialist training in Ireland and the UK. She completed a Wellcome Trust Clinical PhD Fellowship at the University of Cambridge, studying the genetics of ANCA-associated vasculitis. She was awarded the 2021 and 2022 RACP Jacquot Research Establishment Fellowship, which support her current research focus in understanding the biological basis of sarcopenia in patients with chronic kidney disease and to determine the relationship between sarcopenia and renal osteodystrophy.
Aim:
This study investigated the predictive value of various frailty diagnostic tools for mortality in patients undergoing maintenance haemodialysis, with a secondary aim of evaluating the combined effect of frailty and sarcopenia.
Background:
Frailty, an age-related decline in physiological reserves, increases vulnerability to stressors and adverse outcomes such as dependency and death. While closely linked, sarcopenia—a condition involving muscle loss—remains a distinct clinical syndrome. Multiple frailty assessment tools exist, but no consensus has been established for dialysis patients.
Methods:
A cohort of 81 patients on maintenance dialysis (64% male, mean age 73) was followed from May 2021 to March 2025. Frailty was assessed at baseline using the Clinical Frailty Scale (CFS), Edmonton Frailty Scale (EFS), and modified Fried Criteria (FC). Sarcopenia was determined through bioelectrical impedance analysis, handgrip strength, and physical performance testing. Survival analyses were performed using Kaplan-Meier curves and Cox proportional hazard models.
Results:
Pre-frailty and frailty were found in 33–46% of participants, while sarcopenia affected 74%. During follow-up, 20 patients died from various causes, including dialysis withdrawal, infection, cardiovascular events, and cancer. Statistically significant differences in survival were observed for frailty classifications based on CFS (p=0.04) and EFS (p<0.01), but not FC (p=0.11). The worst survival outcomes were noted in patients with both frailty and sarcopenia. Multivariate analysis showed that frailty, as measured by CFS and EFS, independently predicted mortality after adjusting for confounders.
Conclusions:
The study concludes that CFS and EFS are practical tools for routine frailty screening. Their application may facilitate earlier interventions, better risk stratification, and improved patient outcomes.