Kutner Nancy G, Zhang Rebecca
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Front Nephrol. 2023 Jan 20;3:1031338. doi: 10.3389/fneph.2023.1031338. eCollection 2023.
This study examines frailty status evolution observed in a two-year follow-up of a cohort of older persons (age ≥65) with chronic kidney disease (CKD) undergoing maintenance hemodialysis (HD) treatment. Frailty, a geriatric syndrome that connotes a state of low physiologic reserve and vulnerability to stressors, is associated with increased risk for multiple adverse health outcomes in studies of persons with CKD as well as older persons in the general population. The Fried frailty index defines frailty as the presence of 3 or more of 5 indicators-recent unintentional weight loss, slowed gait speed, decreased muscle strength, self-reported exhaustion, and low physical activity. In the seminal work by Fried and colleagues, persons who were characterized by 1-2 of the Fried index criteria were termed "pre-frail" and considered at risk for subsequently becoming frail, potentially providing insight regarding intervention targets that might slow or prevent individuals' transition from pre-frail to frail status. Other less frequently studied types of transitions may also be informative, including "recovery or reversion" (improvement) by people whose longitudinal assessments indicate movement from frailty to prefrailty or robust, or from prefrailty to robust. These status changes are also a potential source of insights relevant for prevention or remediation of frailty, but research focusing on the various ways that individuals may transition between frailty states over time remains limited, and no previous research has examined varying patterns of frailty status evolution in an older cohort of persons with dialysis-dependent CKD. In a study cohort of dialysis-dependent older persons, we characterized patterns of frailty status evolution by age, sex, race/ethnicity, and treatment vintage; by longitudinal profiles of non-sedentary behavior; and by self-report indicators relevant for dimensions emphasized in the Age-Friendly 4Ms Health System (What Matters, Mobility, Mentation). Our study suggests that strategies to promote resiliency among older persons with dialysis-dependent CKD can be informed not only by frailty status transition that indicates improvement over time but also by older adults' maintenance of (stable) robust status over time, and we concur that inclusion of both frailty and resilience measures is needed in future longitudinal studies and clinical trials.
本研究考察了一组接受维持性血液透析（HD）治疗的慢性肾脏病（CKD）老年患者（年龄≥65岁）在两年随访期间观察到的衰弱状态演变情况。衰弱是一种老年综合征，意味着生理储备低和易受应激源影响的状态，在CKD患者以及一般人群中的老年人研究中，衰弱与多种不良健康结局风险增加相关。弗里德衰弱指数将衰弱定义为存在5项指标中的3项或更多项，即近期非故意体重减轻、步态速度减慢、肌肉力量下降、自我报告的疲惫和身体活动量低。在弗里德及其同事的开创性研究中，符合1 - 2项弗里德指数标准的人被称为“衰弱前期”，并被认为有随后变得衰弱的风险，这可能为减缓或防止个体从衰弱前期转变为衰弱状态的干预目标提供见解。其他较少被研究的转变类型可能也具有参考价值，包括纵向评估显示从衰弱转变为衰弱前期或健康状态，或从衰弱前期转变为健康状态的人出现“恢复或逆转”（改善）。这些状态变化也是预防或改善衰弱相关见解的潜在来源，但关注个体随时间在衰弱状态之间可能转变的各种方式的研究仍然有限，并且以前没有研究考察过依赖透析的CKD老年人群中不同的衰弱状态演变模式。在一个依赖透析的老年人群研究队列中，我们按年龄、性别、种族/族裔和治疗时间来描述衰弱状态演变模式；通过非久坐行为的纵向概况；以及通过与“关爱老年人4M健康系统”（重要事项、活动能力、思维能力）所强调维度相关的自我报告指标。我们的研究表明，促进依赖透析的CKD老年患者恢复力的策略不仅可以通过随时间显示改善的衰弱状态转变来指导，还可以通过老年人随时间维持（稳定的）健康状态来指导，并且我们赞同在未来的纵向研究和临床试验中需要纳入衰弱和恢复力测量指标。
