Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Clin J Am Soc Nephrol. 2021 Apr 7;16(4):552-559. doi: 10.2215/CJN.12480720. Epub 2021 Mar 26.
Frailty is common in patients with CKD. Little is known about the prevalence of frailty and its effect on prognosis and decisions surrounding dialysis modalities in patients with advanced CKD (eGFR<30 ml/min per 1.73 m). Our objective was to determine the agreement between different frailty measures and physical function and their association with dialysis modality choice (home based versus in-center) and all-cause mortality in patients with advanced CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study was a prospective, multicenter, cohort study. In 603 patients with advanced CKD, we collected demographics, comorbidities, and laboratory results in addition to objective (Fried frailty criteria) and subjective measures of frailty (physician and nurse impressions) and physical function (Short Physical Performance Battery). Logistic regression and Cox proportional hazards models were used to evaluate the association of frailty with dialysis modality choice and all-cause mortality, respectively.
The prevalence of frailty varied with assessment tool used (Fried frailty criteria, 34%; Short Physical Performance Battery, 55%; physician impression, 44%; nurse impression, 36%). The agreement between all frailty and physical function measures was poor. We had 227 patients reach kidney failure and decide on a dialysis therapy, and 226 patients died during a mean follow-up of 1455 days. After adjusting for age, sex, and comorbid conditions, the Fried criteria and Short Physical Performance Battery were associated with a two-fold higher risk of all-cause mortality (hazard ratio, 1.96; 95% confidence interval, 1.47 to 2.61 and hazard ratio, 1.96; 95% confidence interval,1.42 to 2.76, respectively). Patients deemed as frail by physician and nurse frailty impressions were three to four times more likely to choose in-center dialysis (odds ratio, 3.41; 95% confidence interval, 1.56 to 7.44; odds ratio, 3.87; 95% confidence interval, 1.76 to 8.51, respectively).
We found that the agreement between objective and subjective measures of frailty and physical function was poor. Objective measures of frailty and physical function were associated with mortality, and subjective measures of frailty were associated with dialysis modality choice.
衰弱在慢性肾脏病（CKD）患者中很常见。对于衰弱的流行程度及其对晚期 CKD（eGFR<30 ml/min per 1.73 m）患者预后和透析方式选择（家庭透析与中心透析）的影响，我们知之甚少。我们的目的是确定不同衰弱测量方法与身体功能之间的一致性，并评估其与晚期 CKD 患者的透析方式选择（家庭透析与中心透析）和全因死亡率的相关性。
设计、设置、参与者和测量方法：我们的研究是一项前瞻性、多中心队列研究。在 603 名晚期 CKD 患者中，我们收集了人口统计学、合并症和实验室结果，以及客观（弗莱德衰弱标准）和主观的衰弱（医生和护士的印象）和身体功能（简短体能测试）测量。使用逻辑回归和 Cox 比例风险模型分别评估衰弱与透析方式选择和全因死亡率的相关性。
使用不同的评估工具，衰弱的患病率也不同（弗莱德衰弱标准为 34%；简短体能测试为 55%；医生印象为 44%；护士印象为 36%）。所有衰弱和身体功能测量之间的一致性较差。我们有 227 名患者进入肾衰竭并决定进行透析治疗，226 名患者在平均 1455 天的随访期间死亡。在调整年龄、性别和合并症后，弗莱德标准和简短体能测试与两倍的全因死亡率相关（风险比 1.96；95%置信区间 1.47 至 2.61 和风险比 1.96；95%置信区间 1.42 至 2.76）。医生和护士衰弱印象认为衰弱的患者选择中心透析的可能性高出三到四倍（比值比 3.41；95%置信区间 1.56 至 7.44；比值比 3.87；95%置信区间 1.76 至 8.51）。
我们发现，客观和主观衰弱及身体功能测量之间的一致性较差。客观的衰弱和身体功能测量与死亡率相关，而主观的衰弱测量与透析方式选择相关。
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