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Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 Jul 07; Vol. 12 (7), pp. 1100-1108. Date of Electronic Publication: 2017 Jun 02. - Publication Year :
- 2017
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2017 by the American Society of Nephrology.)
- Subjects :
- Adult
Aged
Biomarkers blood
Comorbidity
Diabetes Mellitus ethnology
Female
Frailty blood
Frailty ethnology
Frailty mortality
Georgia epidemiology
Health Status
Hispanic or Latino
Hospitalization
Humans
Inflammation Mediators blood
Interleukin-6 blood
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic ethnology
Kidney Failure, Chronic mortality
Male
Middle Aged
Risk Factors
San Francisco epidemiology
Serum Albumin, Human metabolism
Time Factors
Treatment Outcome
Frailty diagnosis
Kidney Failure, Chronic therapy
Renal Dialysis adverse effects
Renal Dialysis mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 12
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 28576906
- Full Text :
- https://doi.org/10.2215/CJN.12131116