In a national cohort of patients starting renal replacement therapy, Bao and colleagues1 classified 73% as frail using a modification of criteria proposed by Fried et al2 in their seminal delineation of a frailty phenotype. Bao et al1(p1071) describe frailty as “extremely common among patients starting dialysis in the United States” and, more generally, as a “clinical syndrome highly prevalent in the population with end-stage renal disease (ESRD).” While we fully support the recognition of frailty and understanding of contributors to frailty as valuable research objectives, the article by Bao et al1 provides a case in point that assignment of frailty classification is very dependent on the particular criteria and operational measures that are applied. In particular, reliance on a patient-reported measure of physical functioning (PF) as a substitute for performance-based measures of weakness and slowness specified in the frailty phenotype validated by Fried et al2 may yield a different picture of the prevalence of “frailty.”
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Care at the Close of Life EDUCATION GUIDES
Practical Considerations in Dialysis Withdrawal
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.