Associations between frailty trajectories and cardiovascular, renal, and mortality outcomes in chronic kidney disease

Abstract

Background Frailty is characterized by the loss of biological reserves and vulnerability to adverse outcomes. In individuals with chronic kidney disease (CKD), numerous pathophysiological factors may be responsible for frailty development including inflammation, physical inactivity, reduced energy intake, and metabolic acidosis. Given that both CKD and frailty incur a significant healthcare burden, it is important to understand the relationship of CKD and frailty in real-world routine clinical practice, and how simple frailty assessment methods (e.g. frailty indexes) may be useful. We investigated the risk of frailty development in CKD and the impact of frailty status on mortality and end-stage kidney disease (ESKD). Methods A retrospective cohort study using primary care records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics and the UK Office for National Statistics was undertaken in 819 893 participants aged ≥40 years, of which 140 674 had CKD. Frailty was defined using an electronic frailty index, generated electronically from primary care records. Cox proportional hazard and flexible parametric survival models were used to investigate the risk of developing frailty and the effect of frailty on risk of all-cause and cardiovascular mortality, and ESKD. ResultsThe mean age of those with CKD was 77.5 (SD 9.7) years [61.0 (SD 12.1) years in no-CKD group]; 62.0% of the CKD group were female (compared with 53.3% in no-CKD group). The mean estimated glomerular filtration rate of those with CKD was 46.1 (SD 9.9) mL/min/1.73 m 2 . The majority of those with CKD (75.3%) were frail [vs. 45.4% in those without CKD (no-CKD)]. Over 3 years (median), 69.5% of those with CKD developed frailty. Compared with no-CKD, those with CKD had increased rates of developing mild (hazard ratio: 1.02; 95% confidence interval: 1.01-1.04),

Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review

“… 8 , 9 ) Unfortunately, frailty is common, affecting an estimated 11% of community-dwelling adults aged ≥65 years. 11 ) The prevalence of frailty is especially high in the oldest older adults (≥80 years), 12 ) those residing in low- and middle-income countries, 13 ) residents of long-term care facilities, 14 ) and populations with chronic diseases such as chronic obstructive pulmonary disease, 15 ) chronic kidney disease, 16 ) cancer, 17 ) and cardiovascular disease. 18 ) The likelihood of developing frailty is affected by inequalities in socioeconomic position.…”

Association between pulmonary function and rapid kidney function decline: a longitudinal cohort study from CHARLS

“…PEF monitoring, as an easily accessible lung function index, has been found to be non-inferior to spirometry for screening purposes of lung dysfunction 37. Additionally, PEF has been described as a component of the diagnosis of respiratory sarcopenia, which is associated with worsened renal function and a high risk of ESRD 38–40…”

Association between frailty and chronic kidney disease: Findings from CHARLS

“…Illnesses: Participants reported whether they had been diagnosed with the following conditions: hypertension (subjects were diagnosed as hypertension when the systolic blood pressure was ≥140 mmHg or the diastolic pressure was ≥90 mmHg or self-reported hypertension), dyslipidemia, diabetes, cancer (excluding mild skin cancer), lung disease, liver disease, heart disease, stroke, stomach disease, depression, memory-related disease and arthritis/rheumatism. For this analysis, to investigate the role of the index independent of CKD, we removed CKD (9). Participants with ≥5 diseases were de ned as having the disease.…”

“…For example, Roshanravan et.al found that the prevalence of frailty (14.0%) in CKD participants was twice that of the much older non-CKD reference population (P < 0.01) and the frailty phenotype was associated with an estimated 2.5 (95% CI, 1.4-4.4)-fold greater risk of death or dialysis therapy(8). Besides, a study involving 819 893 participants aged ≥ 40 years found that the majority of those with CKD (75.3%) were frail [vs. 45.4% in those without CKD (no-CKD)] and frailty was associated with increased rates of end-stage kidney disease (ESKD) and all-cause and cardiovascular-related mortality (9). However, whether frailty leads to an increased incidence of CKD remains an under-explored question.…”