Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada.
Perit Dial Int. 2019 Nov-Dec;39(6):532-538. doi: 10.3747/pdi.2018.00195. Epub 2019 Oct 3.
Patients on home dialysis therapies experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. We investigated the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies.We collected objective (Fried criteria and Short Physical Performance Battery [SPPB]), and subjective (physician and nurse impression) measures of frailty from 109 prevalent home dialysis patients. Our primary outcome was a composite of technique failure, defined as a permanent unplanned transition (> 30 days in duration) to facility-based hemodialysis or all-cause death. The association between different frailty assessment tools and the primary composite outcome was evaluated using Cox models.Fried criteria and physician impression was associated with a greater than 2-fold increase in risk of our composite outcome (HR: 2.10 [95% CI 1.09 - 3.99], 2.15 [95% CI 1.15 - 4.00, respectively] in adjusted analyses. Weakness and weight loss subdomains of the Fried criteria were both associated with an increased risk of our composite outcome in adjusted analyses (HR: 2.16 [95% CI 1.23 - 3.78], 2.69 [95% CI 1.39 - 5.40], respectively).Objective and subjective measures of frailty are associated with a more than 2-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management.
居家透析患者会经历技术失败，这与发病率和死亡率有关。技术失败的原因很复杂，通常与患者或护理人员的功能下降有关。虚弱与不良健康结果的风险增加有关。我们调查了虚弱对居家透析患者前瞻性队列中技术失败和死亡率的影响。我们从 109 例现患居家透析患者中收集了虚弱的客观（弗莱德标准和简短体能状况量表[SPPB]）和主观（医生和护士印象）测量指标。我们的主要结局是技术失败的综合指标，定义为永久性、无计划的过渡（持续时间>30 天）到基于设施的血液透析或全因死亡。使用 Cox 模型评估不同虚弱评估工具与主要复合结局之间的关联。弗莱德标准和医生印象与我们复合结局的风险增加超过 2 倍相关（调整后的 HR：2.10[95%CI 1.09-3.99]，2.15[95%CI 1.15-4.00]）。调整后的分析中，弗莱德标准的虚弱和体重减轻亚域均与我们复合结局的风险增加相关（HR：2.16[95%CI 1.23-3.78]，2.69[95%CI 1.39-5.40]）。客观和主观的虚弱测量与居家透析患者技术失败或死亡的风险增加超过 2 倍相关。将虚弱评估作为居家透析治疗临床评估的一部分可能有助于预后和临床管理。
