Frailty-Informed Assessment in Peritoneal Dialysis: A Multicenter Survey of Current Practice and Implementation Barriers in Spain

Background/Objectives: Frailty is increasingly recognized as a major determinant of adverse outcomes in patients receiving peritoneal dialysis (PD), yet it is not routinely incorporated into clinical practice. Because PD relies heavily on patient autonomy and self-management, frailty, sarcopenia, malnutrition, and impaired quality of life may compromise both outcomes and technique retention. This study aimed to describe current clinical practices related to frailty-informed assessment in PD units participating in the GCDP network and to identify barriers to implementing a more comprehensive, patient-centered approach. Methods: We conducted a descriptive, observational, cross-sectional study based on a survey distributed to PD units belonging to the Grupo Centro de Diálisis Peritoneal (GCDP), a collaborative network of 24 hospitals across four autonomous communities in Spain. Physicians and nurses completed the questionnaire between January and February 2025. The survey explored seven domains: use of frailty scales, nutritional screening tools, dynamometry, muscle ultrasound, bioimpedance, quality of life instruments, and digital applications for patient follow-up. Results: Twenty of 24 centers completed the survey. Although all units considered frailty clinically relevant, only 11 assessed it at PD initiation and only 5 performed periodic or systematic re-evaluation. Nutritional screening tools were used in 13 centers, most commonly the Malnutrition Inflammation Score. Twelve centers had a dynamometer, though its use was not standardized. All centers used bioimpedance—primarily for hydration assessment—while muscle ultrasound was rarely applied in scheduled follow-up. Only 7 centers assessed quality of life. The main reported barriers were lack of time in routine practice and the absence of specific guidelines and training. Conclusions: Frailty-related assessment across participating GCDP units remains heterogeneous and incompletely implemented despite broad recognition of its clinical relevance. The identified gaps in standardized protocols, training, and integration of assessment tools highlight priorities for future implementation research aimed at incorporating frailty-informed, patient-centered assessment into routine PD care.