Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.
Western Australian Country Health Service, Busselton Health Campus, West Busselton, WA, 6280, Australia.
BMC Geriatr. 2023 Oct 16;23(1):664. doi: 10.1186/s12877-023-04365-4.
Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality.
Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records.
Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI.
Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.
衰弱在患有慢性肾脏病（CKD）的老年人中很常见，但缺乏强有力的证据支持在此情况下透析的益处。我们旨在长期测量患有晚期 CKD 的老年人的衰弱和生活质量（QOL），并评估开始透析对衰弱、QOL 和死亡率的影响。
年龄≥65 岁且 eGFR≤20ml/minute/1.73m2 的门诊患者参加了一项前瞻性观察研究，并在四年后进行了随访。使用衰弱指数（FI）测量衰弱状况，使用 EuroQol 5D-5L 工具评估 QOL。通过检查电子记录确定死亡率和透析状态。
共纳入 98 名参与者。在入组和随访期间，36%的参与者开始透析，59%的参与者死亡。衰弱的患病率从基线时的 47%增加到随访时的 86%（中位数 FI 变化为 0.22，p<0.001）。开始透析与 FI 的变化无显著相关性。QOL 从基线到随访时下降（平均 EQ-5D-5L 视觉模拟评分从 70 降至 63，p=0.034），但开始透析与 QOL 的下降幅度较小有关。FI 基线增加 0.1 个单位与死亡率危险比增加 59%（HR=1.59，95%CI=1.20 至 2.12，p=0.001）相关，开始透析与死亡率危险比降低 59%（HR=0.41，95%CI=0.20 至 0.87，p=0.020）相关，无论 FI 基线如何。
衰弱在四年内显著增加，基线时衰弱程度越高，死亡率越高。开始透析不会影响 FI 的轨迹，但会对从基线到随访的 QOL 轨迹产生积极影响。在样本量小的限制内，我们的数据表明，虚弱的参与者从透析中获得的生存获益与非虚弱的参与者相似。
