{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:05:21Z","timestamp":1790395521927,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Leading the Change, Zorgevaluatie Nederland","award":["DIALOGICA"],"award-info":[{"award-number":["DIALOGICA"]}]},{"name":"Leading the Change, Zorgevaluatie Nederland","award":["DIALOGICA"],"award-info":[{"award-number":["DIALOGICA"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Both Clinical Frailty Scale score \u22655 and Surprise Question answer no are associated with higher 1-year mortality risk in older patients with advanced CKD.<\/jats:p>\n <\/jats:list-item>\n \n The strongest association with mortality can be found by combining assessments when both indicate high risk.<\/jats:p>\n <\/jats:list-item>\n \n Implementing the Clinical Frailty Scale and Surprise Question may help guide decisions for either KRT or conservative kidney management and highlight patients for whom advance care planning should be initiated.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Frailty is common in older patients with advanced CKD and is associated with mortality. This study investigates whether the Clinical Frailty Scale (CFS) and Surprise Question (Would you be surprised if this patient died in the next 12 months?, SQ) are associated with 1-year mortality and whether combining risk assessments has benefits.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients \u226565 years with eGFR 20\u201310 ml\/min per 1.73 m\n 2<\/jats:sup>\n were included from the ongoing prospective observational cohort study DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (first inclusion May 13th, 2020). Frailty was screened using the CFS, and the SQ was answered using clinical impression (gestalt). Patients were classified high risk with CFS score \u22655 and\/or SQ answer no. Four subgroups were formed: high risk, CFS \u22655 & SQ no; high risk, CFS \u22655 only; high risk, SQ no only; and low risk, CFS <5 & SQ yes. Associations with 1-year mortality were explored using Kaplan\u2013Meier curves and adjusted Cox proportional hazards models.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 589 patients were included (male sex 70%, mean age 77\u00b16 years, mean eGFR 15\u00b13 ml\/min per 1.73 m\n 2<\/jats:sup>\n ). CFS score \u22655 was found in 125 patients (21%) and 112 patients (19%) had SQ answer no. Both CFS score \u22655 (adjusted hazard ratio [HR], 3.09; 95% CI, 1.75 to 5.54) and SQ answer no (adjusted HR, 1.96; 95% CI, 1.09 to 3.52) were associated with higher mortality risk. Subgroup high risk, CFS \u22655 and SQ no had the highest mortality risk (adjusted HR, 3.37; 95% CI, 1.65 to 6.91).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Both CFS score \u22655 and SQ answer no are associated with higher 1-year mortality risk in older patients with advanced CKD. The strongest association with mortality was found by combining both assessments, when both indicate high risk. These findings may help older patients and nephrologists make better informed treatment decisions and initiate timely advance care planning conversations.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000936","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:02:36Z","timestamp":1755792156000},"page":"107-116","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Frailty Scale, Surprise Question and 1-year Mortality in Older Patients with Advanced CKD"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7615-7176","authenticated-orcid":false,"given":"Imre","family":"Demirhan","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands"},{"name":"Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-2860","authenticated-orcid":false,"given":"Micha","family":"Jongejan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7459-9656","authenticated-orcid":false,"given":"Mathijs","family":"van Oevelen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0030-8829","authenticated-orcid":false,"given":"Keanu","family":"Kiriwenno","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3106-3568","authenticated-orcid":false,"given":"Simon P.","family":"Mooijaart","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-6428","authenticated-orcid":false,"given":"Marianne C.","family":"Verhaar","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5062-2567","authenticated-orcid":false,"given":"Willem Jan W.","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke","family":"Joosten","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trijntje T.","family":"Cnossen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolijn","family":"van Buren","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden University Medical Center, Leiden, 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