We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Frailty in Dialysis-Dependent Patients With End-Stage Renal Disease—Reply

Yeran Bao, MD; Kirsten L. Johansen, MD
JAMA Intern Med. 2013;173(1):78-79. doi:10.1001/jamainternmed.2013.1411.
Text Size: A A A
Published online


In reply

We agree with Kutner and Zhang that the assignment of frailty depends on the particular criteria used and operational measures applied. We are also fully aware of the difference between self-reported physical function (PF) and physical performance as measured by grip strength or gait speed. However, when not all measures in the original definition of frailty by Fried et al1 are available, we believe that any substitute measures should correlate well with the original criteria and that the adapted definition should predict adverse health outcomes, a key component in the conceptual framework of frailty. Johansen et al2 have previously shown that the PF scale of the Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) correlated strongly with physical performance as measured by gait speed in patients with end-stage renal disease (ESRD). In the Women's Health Initiative clinical trial, there was also good correlation between the PF scale of the SF-36 and physical performance as measured by gait speed and grip strength.3 In addition, the adaptation of the original definition of frailty by Fried et al1 to a questionnaire-based assessment has been adopted by others in studying both non-ESRD and ESRD populations and has been shown to be associated with adverse health outcomes including mortality.3,4 Thus, we believe that our adaptation of Fried and colleagues' original frailty definition is valid because the substitute measures correlate with the original criteria, and the final modification remains a valid predictor of mortality and morbidity in patients with ESRD.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview





January 14, 2013
Nancy G. Kutner, PhD; Rebecca Zhang, MS
JAMA Intern Med. 2013;173(1):78-79. doi:10.1001/2013.jamainternmed.750.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles