虚弱，但认知障碍没有，提高了慢性肾脏病患者的死亡率风险预测-一项全国代表性研究。

Frailty, but not cognitive impairment, improves mortality risk prediction among those with chronic kidney disease-a nationally representative study.

机构信息

Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.

Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.

出版信息

BMC Nephrol. 2024 May 22;25(1):177. doi: 10.1186/s12882-024-03613-y.

DOI:10.1186/s12882-024-03613-y

PMID:38778286

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11112880/

Abstract

BACKGROUND

Though older adults with chronic kidney disease (CKD) have a greater mortality risk than those without CKD, traditional risk factors poorly predict mortality in this population. Therefore, we tested our hypothesis that two common geriatric risk factors, frailty and cognitive impairment, and their co-occurrence, might improve mortality risk prediction in CKD.

METHODS

Among participants aged ≥ 60 years from National Health and Nutrition Examination Survey (2011-2014), we quantified associations between frailty (physical frailty phenotype) and global/domain-specific cognitive function (immediate-recall [CERAD-WL], delayed-recall [CERAD-DL], verbal fluency [AF], executive function/processing speed [DSST], and global [standardized-average of 4 domain-specific tests]) using linear regression, and tested whether associations differed by CKD using a Wald test. We then tested whether frailty, global cognitive impairment (1.5SD below the mean), or their combination improved prediction of mortality (Cox models, c-statistics) compared to base models (likelihood-ratios) among those with and without CKD.

RESULTS

Among 3,211 participants, 1.4% were cognitively impaired, and 10.0% were frail; frailty and cognitive impairment co-occurrence was greater among those with CKD versus those without (1.2%vs.0.1%). Frailty was associated with worse global cognitive function (Cohen's d = -0.26SD,95%CI -0.36,-0.17), and worse cognitive function across all domains; these associations did not differ by CKD (p > 0.05). Mortality risk prediction improved only among those with CKD when accounting for frailty (p < 0.001) but not cognitive impairment.

CONCLUSIONS

Frailty is associated with worse cognitive function regardless of CKD status. While CKD and frailty improved mortality prediction, cognitive impairment did not. Risk prediction tools should incorporate frailty to improve mortality prediction among those with CKD.

摘要

背景

尽管患有慢性肾脏病（CKD）的老年人的死亡率高于无 CKD 的老年人，但传统的风险因素并不能很好地预测该人群的死亡率。因此，我们检验了这样一个假设，即两种常见的老年风险因素，衰弱和认知障碍，以及它们的同时存在，可能会改善 CKD 患者的死亡率预测。

方法

在来自国家健康和营养调查（2011-2014 年）的年龄≥60 岁的参与者中，我们使用线性回归量化了衰弱（身体衰弱表型）与整体/特定领域认知功能（即刻回忆[CERAD-WL]、延迟回忆[CERAD-DL]、语言流畅性[AF]、执行功能/处理速度[DSST]和整体[4 个特定领域测试的标准化平均]）之间的关联，并使用 Wald 检验检验了这些关联是否因 CKD 而有所不同。然后，我们测试了在有和没有 CKD 的情况下，衰弱、整体认知障碍（低于平均值 1.5 个标准差）或两者的组合是否改善了死亡率的预测（Cox 模型，C 统计量），与基础模型（似然比）相比。

结果

在 3211 名参与者中，1.4%的人认知受损，10.0%的人衰弱；与无 CKD 者相比，有 CKD 者中衰弱和认知障碍的共现率更高（1.2%比 0.1%）。衰弱与整体认知功能较差相关（Cohen's d=-0.26SD，95%CI-0.36，-0.17），且与所有领域的认知功能均较差相关；这些关联不因 CKD 而有所不同（p>0.05）。只有在考虑到衰弱时，CKD 患者的死亡率预测才会改善（p<0.001），而考虑认知障碍时则不会。