Department of Nephrology, Children's National Health System, 111 Michigan Ave NW, Washington DC, 20010, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2019 Dec;34(12):2563-2569. doi: 10.1007/s00467-019-04313-8. Epub 2019 Aug 2.
Frailty is a condition of decreased physiologic reserve and increased vulnerability to stressors. Frailty in combination with inflammation has been associated with increased mortality risk in adults with advanced chronic kidney disease (CKD). This study aimed to investigate prevalence and outcomes associated with a frailty-inflammation phenotype, or "fragility," in children with CKD.
We analyzed 557 children (age 6-19 years, eGFR 30-90 ml/min/1.73 m) from the Chronic Kidney Disease in Children (CKiD) study. Based on adult models, the CKiD fragility model included four indicators: (1) suboptimal growth/weight gain (BMI < 5th percentile-for-height-age, deceleration ≥ 10 BMI-for-height-age percentiles/1 year, height-for-age percentile < 3rd or deceleration ≥ 10 height percentiles/1 year); (2) low muscle mass (mid-upper-arm circumference < 5th percentile or deceleration ≥ 10 percentiles/1 year); (3) fatigue (parent/child report); (4) inflammation (CRP > 3 mg/l). Logistic regression was used to evaluate association of fragility indicators with three adverse outcomes: frequent infection (> 1 per year/3 years), hospitalization (any), and rapid CKD progression (decline in eGFR > 30% or initiation of renal replacement therapy within 3 years).
Prevalence of fragility indicators 1 year after study entry were 39% (suboptimal growth/weight gain), 62% (low muscle mass), 29% (fatigue), and 18% (inflammation). Prevalence of adverse outcomes during the subsequent 3 years were 13% (frequent infection), 22% (hospitalization), and 17% (rapid CKD progression). Children with ≥ 3 fragility indicators had 3.16-fold odds of frequent infection and 2.81-fold odds of hospitalization, but did not have rapid CKD progression.
A fragility phenotype, characterized by the presence of ≥ 3 indicators, is associated with adverse outcomes, including infection and hospitalization in children with CKD.
衰弱是一种生理储备减少和对压力源易感性增加的状态。衰弱与炎症相结合与晚期慢性肾脏病（CKD）成人的死亡率风险增加有关。本研究旨在调查与 CKD 儿童的衰弱-炎症表型或“脆弱性”相关的患病率和结局。
我们分析了来自慢性肾脏病儿童（CKiD）研究的 557 名儿童（年龄 6-19 岁，eGFR 30-90ml/min/1.73m）。基于成人模型，CKiD 脆弱模型包括四个指标：（1）生长/体重增长不良（BMI<身高年龄的第 5 百分位，身高年龄百分位的减速≥10%/年，身高年龄百分位<第 3 百分位或减速≥10%/年）；（2）肌肉量低（中上臂围<第 5 百分位或减速≥10%/年）；（3）疲劳（父母/孩子报告）；（4）炎症（CRP>3mg/l）。使用逻辑回归评估脆弱性指标与三种不良结局的关联：频繁感染（>1 次/年/3 年）、住院（任何）和 CKD 快速进展（eGFR 下降>30%或在 3 年内开始肾脏替代治疗）。
研究入组后 1 年时脆弱性指标的患病率为 39%（生长/体重增长不良）、62%（肌肉量低）、29%（疲劳）和 18%（炎症）。随后 3 年内不良结局的患病率为 13%（频繁感染）、22%（住院）和 17%（快速 CKD 进展）。≥3 个脆弱性指标的儿童频繁感染的几率是 3.16 倍，住院的几率是 2.81 倍，但没有快速 CKD 进展。
具有≥3 个指标的脆弱表型与不良结局相关，包括 CKD 儿童的感染和住院。
