Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis

Clinical journal of the American Society of Nephrology: CJASN

Kirsten L. Johansen⁴  Barbara Grimes⁵ 

[1] and..‡Department of Epidemiology and Biostatistics, University of California, San Francisco, California;**Division of Nephrology and..††Department of Biochemistry and Molecular Medicine, University of California, Davis, California..;Divisions of *Nephrology and..†Nephrology and Endocrinology Sections, San Francisco Veterans Affairs Medical Center, San Francisco, California;§Fresenius Medical Care North America, Waltham, Massachusetts;‖Division of Nephrology, Stanford University School of Medicine, Stanford, California;†Nephrology and Endocrinology Sections, San Francisco Veterans Affairs Medical Center, San Francisco, California;‡Department of Epidemiology and Biostatistics, University of California, San Francisco, California

关键词: hemodialysis;    frailty;    end-stage renal disease;    physical function;    functional status;    chronic kidney disease;    Adiposity;    diabetes mellitus;    Follow-Up Studies;    Hispanic Americans;    hospitalization;    Humans;    Inflammation;    Interleukin-6;    obesity;    renal dialysis;    Serum Albumin;    IL6 protein, human;   

DOI  :  10.2215/CJN.12131116

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Frailty is common among patients on hemodialysis and associated with adverse outcomes. However, little is known about changes in frailty over time and the factors associated with those changes.Design, setting, participants, & measurements To address these questions, we examined 762 participants in the A Cohort to Investigate the Value of Exercise/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD cohort study, among whom frailty was assessed at baseline and 12 and 24 months. We used ordinal generalized estimating equations analyses and modeled frailty (on a scale from zero to five possible components) and death during follow-up.Results The mean frailty score at baseline was 1.9, and the distribution of frailty scores was similar at each evaluation. However, most participants’ scores changed, with patients improving almost as often as worsening (overall change, 0.2 points per year; 95% confidence interval, 0.1 to 0.3). Hispanic ethnicity (0.6 points per year; 95% confidence interval, 0.0 to 1.1) and diabetes (0.7 points per year; 95% confidence interval, 0.3 to 1.0) were associated with higher frailty scores and higher serum albumin concentration with lower frailty scores (−1.1 points per g/dl; 95% confidence interval, −1.5 to −0.7). In addition, patients whose serum albumin increased over time were less likely to become frail, with each 1-g/dl increase in albumin associated with a 0.4-point reduction in frailty score (95% confidence interval, −0.80 to −0.05). To examine the underpinnings of the association between serum albumin and frailty, we included serum IL-6, normalized protein catabolic rate, and patient self-report of hospitalization within the last year in a second model. Higher IL-6 and hospitalization were statistically significantly associated with worse frailty at any point and worsening frailty over time, whereas normalized protein catabolic rate was not independently associated with frailty.Conclusions There was substantial year to year variability in frailty scores, with approximately equal numbers of patients improving and worsening. Markers of inflammation and hospitalization were independently associated with worsening frailty. Studies should examine whether interventions to address inflammation or posthospitalization rehabilitation can improve the trajectory of frailty.Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_06_06_Johansen.mp3

【 授权许可】

CC BY