Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.
Biomolecules. 2022 Mar 9;12(3):423. doi: 10.3390/biom12030423.
The negative impact of chronic kidney disease (CKD) on health status and quality of life in older patients has been well documented. However, data on frailty trajectories and long-term outcomes of older CKD patients undergoing structured Comprehensive Geriatric Assessment (CGA) with multidimensional frailty evaluation are sparse. Here, we analysed records from 375 CKD patients admitted to our university hospital (mean age 77.5 (SD 6.1) years, 36% female) who had undergone a CGA-based calculation of the frailty score with the multidimensional prognostic index (MPI) as well as follow-up evaluations at 3, 6 and 12 months after discharge. Based on the MPI score at admission, 21% of the patients were frail and 56% were prefrail. MPI values were significantly associated with KDIGO CKD stages (p = 0.003) and rehospitalisation after 6 months (p = 0.027) and mortality at 3, 6 and 12 months (p = 0.001), independent of chronological age. Kidney transplant recipients (KTR) showed a significantly lower frailty compared to patients with renal replacement therapy (RRT, p = 0.028). The association between frailty and mortality after 12 months appeared particularly strong for KTR (mean MPI 0.43 KTR vs. 0.52 RRT, p < 0.001) and for patients with hypoalbuminemia (p < 0.001). Interestingly, RRT was per se not significantly associated with mortality during follow up. However, compared to patients on RRT those with KTR had a significantly lower grade of care (p = 0.031) and lower rehospitalisation rates at 12 months (p = 0.010). The present analysis shows that the large majority of older CKD inpatients are prefrail or frail and that the risk for CKD-related adverse outcomes on the long term can be accurately stratified by CGA-based instruments. Further studies are needed to explore the prognostic and frailty-related signature of laboratory biomarkers in CKD.
慢性肾脏病（CKD）对老年患者的健康状况和生活质量的负面影响已得到充分证实。然而，关于接受多维衰弱评估的综合老年评估（CGA）的老年 CKD 患者的衰弱轨迹和长期结局的数据很少。在这里，我们分析了 375 名因 CKD 入住我院（平均年龄 77.5（6.1）岁，36%为女性）的患者的记录，他们进行了基于 CGA 的多维预后指数（MPI）衰弱评分计算，以及出院后 3、6 和 12 个月的随访评估。根据入院时的 MPI 评分，21%的患者衰弱，56%为衰弱前期。MPI 值与 KDIGO CKD 分期（p = 0.003）、6 个月后再住院（p = 0.027）和 3、6 和 12 个月的死亡率（p = 0.001）显著相关，与实际年龄无关。肾移植受者（KTR）的衰弱程度明显低于接受肾脏替代治疗的患者（RRT，p = 0.028）。12 个月后衰弱与死亡率之间的关联在 KTR 中尤为明显（平均 MPI 0.43 KTR 与 0.52 RRT，p < 0.001）和低白蛋白血症患者中（p < 0.001）。有趣的是，RRT 本身在随访期间与死亡率无显著相关性。然而，与接受 RRT 的患者相比，接受 KTR 的患者的护理级别明显较低（p = 0.031），12 个月时的再住院率较低（p = 0.010）。本分析表明，大多数老年 CKD 住院患者处于衰弱前期或衰弱期，通过 CGA 为基础的工具可以准确分层 CKD 相关不良结局的风险。需要进一步研究来探讨 CKD 中实验室生物标志物的预后和衰弱相关特征。
