Frailty phenotype and multi-domain impairments in older patients with chronic kidney disease

Abstract

Background Older subjects with chronic kidney disease (CKD) are often affected by multiple geriatric impairments that may benefit from a comprehensive geriatric assessment (CGA). However, ordinary execution of CGA in all these individuals would be unaffordable. We evaluated if Frailty Phenotype (FP) could identify older CKD-patients that may benefit the most from a CGA. Methods We evaluated 112 CKD patients not yet on dialysis (age ≥ 65 years, eGFR < 45 ml/min). FP was defined according to the criteria proposed by Fried and co-authors. CGA evaluated four domains (nutrition, physical performance, cognition and depression). Malnutrition was defined in accordance to Malnutrition-Inflammation Score (MIS) and/or by the presence of Protein Energy Wasting syndrome (PEW). Physical performance was evaluated using Short Physical Performance Battery (SPPB) and handgrip strength. Cognitive status was assessed by using Mini Mental State Examination (MMSE) and Clock Drawing Test. Mood was investigated with Geriatric Depression Scale (GDS). Results Average age of our cohort was 80 ± 6 years and mean eGFR 24 ± 11 ml/min/1.73 m2. Prevalence of frailty was 45%. Frail patients (F-CKD) had higher prevalence of malnutrition (58 vs 29%, p = 0.0005), physical impairment (100% vs 78%; p < 0.0001), cognitive dysfunction (83% vs 37%; p < 0.0001) and depression (50% vs 21%; p < 0.001) compared to robust ones (NF-CKD). Moreover, F-CKD patients had higher probability to have > 2 impaired domains (83% sensitivity and 76% specificity) respect to NF-CKD individuals. Conclusions FP is a reliable screening tool to identify older CKD-patients that may benefit from a CGA.

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

“…Several reasons may be responsible for the observed relationship between frailty and the UTI risk. Patients with frailty frequently have co-existing malnutrition and other geriatric syndromes including sarcopenia, cognitive dysfunction, and/or depression [ 40 , 41 ]. Prior studies showed that having low mini-nutrition assessment (MNA) scores was associated with an increased UTI risk [ 42 ].…”

Renal Function, Cardiovascular Diseases, Appropriateness of Drug Prescription and Outcomes in Hospitalized Older Patients

“…Moreover, we documented how progressively impaired renal function also entailed impaired performance status, with patients requiring more intensive care. Accordingly, the impaired renal function seems to be a clinical feature, able to significantly impact on older patients in terms of frailty [2,3,16] and intrinsic capacity [17]. Furthermore, while the impact of impaired renal function on outcomes has been already described [20,21], with previous studies showing how CKD (eCrCl < 60 mL/min) is associated with short-term outcomes [18,19], the peculiarities of our analysis help us to document and underline this relationship also in a "real-life" older cohort observed over a significant follow-up time.…”

“…The result of these abnormalities, independent of the cause, leads to decreased glomerular filtration rate (GFR) with onset of chronic kidney disease (CKD) [1]. In older individuals, CKD is recognized as one of the main comorbidities, associated with an impaired clinical and functional status [2,3], increased hospitalization, and a higher risk of major clinical outcomes [4,5].…”

“…On the basis of this background, the aims of the present study were (1) to describe clinical and functional status according to renal function classes and clinical determinants of creatinine clearance in a cohort of older hospitalized patients; (2) to evaluate the impact of progressively decreasing renal function on the occurrence of major clinical outcomes; and (3) to assess, in the context of a cohort of patients burdened with a significant risk of adverse outcomes related to the presence of impaired eCrCl, the prevalence of inappropriate prescription according to eCrCl and to evaluate clinical outcomes according to appropriate/inappropriate prescription on the basis of eCrCl. To achieve these aims, we performed an analysis of patients enrolled in the "REgistro POliterapie SIMI" (REPOSI), according to their baseline eCrCl.…”

Participação dos fatores de crescimento de fibroblastos (FGF-21 e FGF-23) e klotho na fragilidade e cognição do paciente idoso com doença renal crônica

“…Pessoas idosas frágeis são quatro vezes mais propensas a terem depressão do que as não frágeis ou robustas179 . Na população com DRC, um estudo que avaliou idosos em tratamento conservador observou uma prevalência de 45% de fragilidade e 50% de depressão nos pacientes frágeis180 . Depressão e fragilidade apresentam-se na literatura como entidades bidirecionais, mas não estão claras as relações de causalidade, em que medida são fenômenos sobrepostos ou, ainda, síndromes distintas177,179 .…”