Factors associated with frailty and its trajectory among patients on hemodialysis

Kirsten L. Johansen, Lorien Dalrymple, Cynthia Delgado, Glenn M. Chertow, Mark R. Segal, Janet Chiang, Barbara Grimes, George Kaysen

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1100-1108
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number7
DOIs
StatePublished - Jul 7 2017

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Renal Dialysis
Confidence Intervals
Serum Albumin
Hospitalization
Interleukin-6
Inflammation
Hispanic Americans
Self Report
Chronic Kidney Failure
Albumins
Proteins
Cohort Studies
Rehabilitation
Obesity
Exercise
Survival
Serum

Keywords

  • Adiposity
  • Chronic kidney disease
  • Diabetes mellitus
  • End-stage renal disease
  • Follow-up studies
  • Frailty
  • Functional status
  • Hemodialysis
  • Hispanic Americans
  • Hospitalization
  • Humans
  • IL6 protein, human
  • Inflammation
  • Interleukin-6
  • Obesity
  • Physical function
  • Renal dialysis
  • Serum Albumin

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Factors associated with frailty and its trajectory among patients on hemodialysis. / Johansen, Kirsten L.; Dalrymple, Lorien; Delgado, Cynthia; Chertow, Glenn M.; Segal, Mark R.; Chiang, Janet; Grimes, Barbara; Kaysen, George.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 7, 07.07.2017, p. 1100-1108.

Research output: Contribution to journalArticle

Johansen, KL, Dalrymple, L, Delgado, C, Chertow, GM, Segal, MR, Chiang, J, Grimes, B & Kaysen, G 2017, 'Factors associated with frailty and its trajectory among patients on hemodialysis', Clinical Journal of the American Society of Nephrology, vol. 12, no. 7, pp. 1100-1108. https://doi.org/10.2215/CJN.12131116
Johansen, Kirsten L. ; Dalrymple, Lorien ; Delgado, Cynthia ; Chertow, Glenn M. ; Segal, Mark R. ; Chiang, Janet ; Grimes, Barbara ; Kaysen, George. / Factors associated with frailty and its trajectory among patients on hemodialysis. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 7. pp. 1100-1108.
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abstract = "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.",
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AU - Johansen, Kirsten L.

AU - Dalrymple, Lorien

AU - Delgado, Cynthia

AU - Chertow, Glenn M.

AU - Segal, Mark R.

AU - Chiang, Janet

AU - Grimes, Barbara

AU - Kaysen, George

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N2 - 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.

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KW - Hispanic Americans

KW - Hospitalization

KW - Humans

KW - IL6 protein, human

KW - Inflammation

KW - Interleukin-6

KW - Obesity

KW - Physical function

KW - Renal dialysis

KW - Serum Albumin

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