Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
J Am Geriatr Soc. 2013 Jun;61(6):896-901. doi: 10.1111/jgs.12266. Epub 2013 May 27.
To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization.
Prospective cohort study.
Single hemodialysis center in Baltimore, Maryland.
One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012.
Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations.
At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P = .046) and 2.6 times (95% CI = 1.04-6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants.
Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations.
定量评估所有年龄段接受慢性血液透析的成年人的衰弱发生率，及其与合并症和残疾的关系，并评估其与死亡率和住院率不良结局的相关性。
前瞻性队列研究。
马里兰州巴尔的摩市的单一体外血液透析中心。
2009 年 1 月至 2010 年 3 月期间入组并于 2012 年 8 月前随访的 146 名接受血液透析的成年人。
在研究入组时评估衰弱、合并症和残疾情况，并评估随后的死亡率和住院率。
入组时，50.0%的老年（≥65 岁）和 35.4%的年轻（<65 岁）血液透析患者衰弱；分别有 35.9%和 29.3%的患者为中度衰弱。非衰弱患者的 3 年死亡率为 16.2%，中度衰弱患者为 34.4%，衰弱患者为 40.2%。中度衰弱和衰弱与死亡风险增加 2.7 倍（95%置信区间（CI）=1.02-7.07，P=0.046）和 2.6 倍（95%CI=1.04-6.49，P=0.04）独立相关，与年龄、性别、合并症和残疾无关。入组后 1 年内，中位住院次数为 1 次（四分位间距 0-3）。2 次或更多次住院的患者比例为：非衰弱患者为 28.2%，中度衰弱患者为 25.5%，衰弱患者为 42.6%。尽管中度衰弱与住院次数无关（相对风险=0.76，95%CI=0.49-1.16，P=0.21），但衰弱与住院次数增加 1.4 倍（95%CI=1.00-2.03，P=0.049）独立相关，与年龄、性别、合并症和残疾无关。衰弱与死亡率（交互 P=0.64）和住院率（P=0.14）之间的相关性在老年和年轻患者之间没有差异。
所有年龄段接受血液透析的成年人衰弱发生率很高，是社区居住的老年成年人的 5 倍以上。在该人群中，衰弱无论在年龄大小，都是死亡率和住院次数的一个强有力的独立预测因素。
