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A prospective study of frailty in nephrology-referred patients with CKD.

Roshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel KV, de Boer IH, Seliger S, Ruzinski J, Himmelfarb J, Kestenbaum B
Am J Kidney Dis. 2012 60 (6): 912-21

PMID: 22770927 · PMCID: PMC3491110 · DOI:10.1053/j.ajkd.2012.05.017

BACKGROUND - Frailty is a construct developed to characterize a state of reduced functional capacity in older adults. However, there are limited data describing the prevalence or consequences of frailty in middle-aged patients with chronic kidney disease (CKD).

STUDY DESIGN - Observational study.

SETTING & PARTICIPANTS - 336 non-dialysis-dependent patients with stages 1-4 CKD with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m(2) (by the CKD-EPI [CKD Epidemiology Collaboration] serum creatinine-based equation) or evidence of microalbuminuria enrolled in the Seattle Kidney Study, a clinic-based cohort study. Findings were compared with community-dwelling older adults in the Cardiovascular Health Study.

OUTCOME - Prevalence and determinants of frailty in addition to its association with the combined outcome of all-cause mortality or renal replacement therapy.

MEASUREMENTS - We defined frailty according to established criteria as 3 or more of the following characteristics: slow gait, weakness, unintentional weight loss, exhaustion, and low physical activity. We estimated kidney function using serum cystatin C concentrations (eGFR(cys)) to minimize confounding due to relationships of serum creatinine levels with muscle mass and frailty.

RESULTS - The mean age of the study population was 59 years and mean eGFR(cys) was 51 mL/min/1.73 m(2). The prevalence of frailty (14.0%) was twice that of the much older non-CKD reference population (P < 0.01). The most common frailty components were physical inactivity and exhaustion. After adjustment including diabetes, eGFR(cys) categories of <30 and 30-44 mL/min/1.73 m(2) were associated with a 2.8- (95% CI, 1.3-6.3) and 2.1 (95% CI, 1.0-4.7)-fold greater prevalence of frailty compared with GFR(cys) ≥60 mL/min/1.73 m(2). There were 63 events during a median 987 days of follow-up. After adjustment, the frailty phenotype was associated with an estimated 2.5 (95% CI, 1.4-4.4)-fold greater risk of death or dialysis therapy.

LIMITATIONS - Cross-sectional study design obscures inference regarding temporal relationships between CKD and frailty.

CONCLUSIONS - Frailty is relatively common in middle-aged patients with CKD and is associated with lower eGFR(cys) and increased risk of death or dialysis therapy.

Copyright © 2012 National Kidney Foundation, Inc. All rights reserved.

MeSH Terms (13)

Aged Cohort Studies Cross-Sectional Studies Female Frail Elderly Glomerular Filtration Rate Humans Male Middle Aged Nephrology Prospective Studies Referral and Consultation Renal Insufficiency, Chronic

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