Abstract
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 m2 (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 (eGFRcys) 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 eGFRcys was 51 mL/min/1.73 m2. 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, eGFRcys categories of <30 and 30-44 mL/min/1.73 m2 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 m2. 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 eGFRcys and increased risk of death or dialysis therapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 912-921 |
| Number of pages | 10 |
| Journal | American Journal of Kidney Diseases |
| Volume | 60 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2012 |
| Externally published | Yes |
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Keywords
- chronic kidney disease
- Frailty
- functional limitation
- mortality
ASJC Scopus subject areas
- Nephrology
Cite this
A prospective study of frailty in nephrology-referred patients with CKD. / Roshanravan, Baback; Khatri, Minesh; Robinson-Cohen, Cassianne; Levin, Greg; Patel, Kushang V.; De Boer, Ian H.; Seliger, Stephen; Ruzinski, John; Himmelfarb, Jonathan; Kestenbaum, Bryan.
In: American Journal of Kidney Diseases, Vol. 60, No. 6, 01.12.2012, p. 912-921.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A prospective study of frailty in nephrology-referred patients with CKD
AU - Roshanravan, Baback
AU - Khatri, Minesh
AU - Robinson-Cohen, Cassianne
AU - Levin, Greg
AU - Patel, Kushang V.
AU - De Boer, Ian H.
AU - Seliger, Stephen
AU - Ruzinski, John
AU - Himmelfarb, Jonathan
AU - Kestenbaum, Bryan
PY - 2012/12/1
Y1 - 2012/12/1
N2 - 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 m2 (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 (eGFRcys) 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 eGFRcys was 51 mL/min/1.73 m2. 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, eGFRcys categories of <30 and 30-44 mL/min/1.73 m2 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 m2. 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 eGFRcys and increased risk of death or dialysis therapy.
AB - 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 m2 (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 (eGFRcys) 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 eGFRcys was 51 mL/min/1.73 m2. 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, eGFRcys categories of <30 and 30-44 mL/min/1.73 m2 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 m2. 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 eGFRcys and increased risk of death or dialysis therapy.
KW - chronic kidney disease
KW - Frailty
KW - functional limitation
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=84868712372&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868712372&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2012.05.017
DO - 10.1053/j.ajkd.2012.05.017
M3 - Article
C2 - 22770927
AN - SCOPUS:84868712372
VL - 60
SP - 912
EP - 921
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 6
ER -