J Korean Med Sci.  2017 Nov;32(11):1800-1806. 10.3346/jkms.2017.32.11.1800.

Is Frailty a Modifiable Risk Factor of Future Adverse Outcomes in Elderly Patients with Incident End-Stage Renal Disease?

• Lee SW
• Lee A
• Yu MY
• Kim SW
• Kim KI
• Na KY
• Chae DW
• Kim CH
• Chin HJ

• KMID: 2390306
• DOI: http://doi.org/10.3346/jkms.2017.32.11.1800

Abstract

Little is known about the clinical significance of frailty and changes of frailty after dialysis initiation in elderly patients with end-stage renal disease (ESRD). We prospectively enrolled 46 elderly patients with incident ESRD at a dialysis center of a tertiary hospital between May 2013 and March 2015. Frailty was assessed by using a comprehensive geriatric assessment protocol and defined as a multidimensional frailty score of ≥ 10. The main outcome was the composite of all-cause death or cardiovascular hospitalization, as determined in June 2016. The median age of the 46 participants was 71.5 years, and 63.0% of them were men. During the median 17.7 months follow-up, the rate of composite outcome was 17.4%. In multivariate logistic regression analysis, after adjusting for age, sex, diabetes, body mass index (BMI), and time of predialytic nephrologic care, female sex, and increased BMI were associated with increased and decreased odds of frailty, respectively. In multivariate Cox proportional hazards analysis, after adjusting for age, sex, diabetes, BMI, and time of predialytic nephrologic care, frailty was significantly associated with the composite adverse outcome. In repeated frailty assessments, the multidimensional frailty score significantly improved 12 months after the initiation of dialysis, which largely relied on improved nutrition. Therefore, frailty needs to be assessed for risk stratification in elderly patients with incident ESRD.

Keyword

Frailty; Dialysis; Malnutrition; End-Stage Renal Disease

MeSH Terms

Aged*
Body Mass Index
Dialysis
Female
Follow-Up Studies
Geriatric Assessment
Hospitalization
Humans
Kidney Failure, Chronic*
Logistic Models
Male
Malnutrition
Prospective Studies
Risk Factors*
Tertiary Care Centers

Figure

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  Fig. 1 Distribution of multidimensional frailty score.

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  Fig. 2 Components of multidimensional frailty score. Higher scores of multidimensional frailty score and its components indicate more frail conditions. CCI = Charlson comorbidity index, IADL = instrumental activities of daily living, ADL = activities of daily living.

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  Fig. 3 Kaplan-Meier survival curve for the composite adverse outcome according to frailty status.

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