Jiang Xinxin, Li Daoting, Shen Wei, Shen Xiaogang, Liu Yueming
Department of Nephrology, Zhejiang Hospital, Hangzhou, Zhejiang Province, P. R. China; Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, P. R. China.
General Medicine Department, Changqing Chaoming Community Health Service Center, Red Cross Hospital of Xiachen District, Hangzhou, Zhejiang Province, P. R. China.
J Ren Nutr. 2020 Nov;30(6):526-534. doi: 10.1053/j.jrn.2019.12.007. Epub 2020 Feb 13.
The in-hospital mortality rate of patients with end-stage renal disease (ESRD) is 6-8 times greater than that of the general population. A large fraction of patients with ESRD are frail, which further exacerbates this poor outcome. This study aimed to determine the impact of frailty on in-hospital outcomes of patients with ESRD.
This population-based, retrospective study used data from the Nationwide Inpatient Sample (NIS), the largest all-payer US inpatient care database. Data of 1,424,026 hospitalized patients on maintenance dialysis between 2005 and 2014 were included. Patients were classified with respect to frailty status. Primary endpoints were all-cause in-hospital mortality, discharge disposition, length of hospital stay, and hospital costs. Patient characteristics included age, sex, race, income, insurance status, and Charlson's comorbidity index. Logistic regression and linear regression analyses were conducted to evaluate the associations between frailty and clinical outcomes.
After adjustment for the confounders, hospitalized patients with frailty on maintenance dialysis were at double the risk of in-hospital mortality, 3 times the risk of discharge to long-term facilities, had hospital stays 5 days longer, and incurred $40,000 more in-hospital costs than those without frailty. The impact of frailty on all these in-hospital outcomes was greater among patients aged <65 years than among older adults.
For hospitalized patients on maintenance dialysis, frailty independently predicts worse in-hospital outcomes, with stronger effects on younger patients. The development of adequate interventions for frailty in patients with ESRD and vigilance in treating this subgroup during hospitalization are highly warranted.
终末期肾病（ESRD）患者的院内死亡率比普通人群高6至8倍。很大一部分ESRD患者身体虚弱，这进一步加剧了这种不良后果。本研究旨在确定身体虚弱对ESRD患者院内结局的影响。
这项基于人群的回顾性研究使用了美国最大的全付费者住院护理数据库——全国住院样本（NIS）的数据。纳入了2005年至2014年间1,424,026例接受维持性透析的住院患者的数据。根据身体虚弱状况对患者进行分类。主要终点为全因院内死亡率、出院处置、住院时间和住院费用。患者特征包括年龄、性别、种族、收入、保险状况和查尔森合并症指数。进行逻辑回归和线性回归分析以评估身体虚弱与临床结局之间的关联。
在对混杂因素进行调整后，接受维持性透析的身体虚弱住院患者的院内死亡风险增加一倍，转至长期护理机构的风险增加3倍，住院时间延长5天，住院费用比非虚弱患者多40,000美元。身体虚弱对所有这些院内结局的影响在65岁以下患者中比在老年人中更大。
对于接受维持性透析的住院患者，身体虚弱独立预测院内结局更差，对年轻患者的影响更强。非常有必要针对ESRD患者的身体虚弱制定适当的干预措施，并在住院期间对该亚组患者保持警惕。
