Kidney function and prevalent and incident frailty

Lorien Dalrymple, Ronit Katz, Dena E. Rifkin, David Siscovick, Anne B. Newman, Linda F. Fried, Mark J. Sarnak, Michelle C. Odden, Michael G. Shlipak

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Abstract

Background and objectives Kidney disease is associatedwith physiologic changes thatmay predispose to frailty. This study sought to investigate whether lower levels of kidney function were associated with prevalent or incident frailty in Cardiovascular Health Study (CHS) participants. Design, setting, participants, & measurements CHS enrolled community-dwelling adults age ≥65 years between 1989-1990 and 1992-1993. To examine prevalent frailty, included were 4150 participants without stroke, Parkinson disease, prescribed medications for Alzheimer disease or depression, or severely impaired cognition. To examine incident frailty, included were a subset of 3459 participants without baseline frailty or development of exclusion criteria during follow-up. The primary predictor was estimated GFR (eGFR) calculated using serum cystatin C (eGFRcys). Secondary analyses examined eGFR using serum creatinine (eGFRSCr). Outcomes were prevalent frailty and incident frailty at 4 years of follow-up. Frailty was ascertained on the basis of weight loss, exhaustion, weakness, slowness, and low physical activity. Results Themean age was 75 years and themedian eGFRcys was 73ml/min per 1.73m2.Among participantswith an eGFRcys <45 ml/min per 1.73 m2, 24% had prevalent frailty. In multivariable analysis and compared with eGFRcys≥90 ml/min per 1.73m2, eGFRcys categories of 45-59 (odds ratio [OR], 1.80; 95%confidence interval [CI], 1.17 to 2.75) and 15-44 (OR, 2.87; 95% CI, 1.72 to 4.77) were associated with higher odds of frailty, whereas 60-75 (OR, 1.14; 95% CI, 0.76 to 1.70) was not. In multivariable analysis, eGFRcys categories of 60-75 (incidence rate ratio [IRR], 1.72; 95% CI, 1.07 to 2.75) and 15-44 (IRR, 2.28; 95% CI, 1.23 to 4.22) were associated with higher incidence of frailty whereas 45-59 (IRR, 1.53; 95% CI, 0.90 to 2.60) was not. Lower levels of eGFRSCr were not associated with higher risk of prevalent or incident frailty. Conclusions In community-dwelling elders, lower eGFRcys was associated with a higher risk of prevalent and incident frailtywhereas lower eGFRSCr was not. These findings highlight the importance of considering non-GFR determinants of kidney function.

Original languageEnglish (US)
Pages (from-to)2091-2099
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number12
DOIs
StatePublished - Dec 6 2013

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ASJC Scopus subject areas

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

Cite this

Dalrymple, L., Katz, R., Rifkin, D. E., Siscovick, D., Newman, A. B., Fried, L. F., Sarnak, M. J., Odden, M. C., & Shlipak, M. G. (2013). Kidney function and prevalent and incident frailty. Clinical Journal of the American Society of Nephrology, 8(12), 2091-2099. https://doi.org/10.2215/CJN.02870313