Hussien Hani, Siriteanu Lucian, Nistor Ionut, Kanbay Mehmet, Covic Andreea, Voroneanu Luminita, Covic Adrian
Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU.
Department of Internal Medicine, Koc University School of Medicine, Istanbul, TUR.
Cureus. 2024 Jul 11;16(7):e64303. doi: 10.7759/cureus.64303. eCollection 2024 Jul.
Background and objectives Frailty and cognitive impairment significantly impact survival time and time to initiate dialysis in older adults with advanced chronic kidney disease (CKD). This study aims to evaluate the effects of frailty and cognitive impairment on these outcomes and determine the most effective assessment tool for predicting early dialysis initiation and short survival time. Materials and methods This prospective observational cohort study involved 240 patients aged ≥65 years with stage 4 or 5 CKD, recruited from a nephrology outpatient department (ambulatory care) between March 2020 and March 2021. Frailty was assessed using the Physical Frailty Phenotype (PFP), PRISMA-7, Clinical Frailty Scale (CFS), and FRAIL scale. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). The primary outcomes were time to initiate dialysis and survival time, with secondary outcomes including hospitalization rates, length of stay, and mortality after dialysis initiation. Results Frail patients only showed significantly shorter time to dialysis initiation when identified by the PFP and FRAIL scale (28.3 months for frail vs. 31.2 months for non-frail, p = 0.028; 26.9 months for frail vs. 30.9 months for non-frail, p = 0.038). The PFP, FRAIL, and CFS tools indicated significantly shorter survival times for frail patients compared to non-frail patients (26.8 months for frail vs. 30.6 months for non-frail, p = 0.003). Frailty is strongly correlated with severe cognitive impairment, as 45.5% of frail patients (according to the FRAIL scale) have dementia compared to 15.1% of non-frail patients (p<0.001). However, cognitive impairment did not significantly affect the time to dialysis initiation or survival time. Hospitalization rates and length of stay in the hospital were significantly higher only for frail patients identified by PRISMA-7, with a median hospital length of stay of 9.15 days for frail patients vs 6.37 days for non-frail patients (p = 0.044). Overall, 37.5% of the patients did not survive during the study follow-up, with frail patients having a higher mortality rate. Conclusion Frailty, mainly when assessed by PFP and FRAIL, is a significant predictor of early dialysis initiation and reduced survival time in older adults with advanced CKD. Cognitive impairment, while prevalent, did not independently predict these outcomes. Regular frailty screening should be incorporated into CKD management to tailor interventions and improve patient outcomes.
衰弱和认知障碍对老年晚期慢性肾脏病（CKD）患者的生存时间和开始透析的时间有显著影响。本研究旨在评估衰弱和认知障碍对这些结局的影响，并确定预测早期透析开始和短生存时间的最有效评估工具。
这项前瞻性观察性队列研究纳入了240例年龄≥65岁的4期或5期CKD患者，于2020年3月至2021年3月从肾脏病门诊（门诊护理）招募。使用身体衰弱表型（PFP）、PRISMA-7、临床衰弱量表（CFS）和衰弱量表评估衰弱情况。使用蒙特利尔认知评估（MoCA）评估认知功能。主要结局为开始透析的时间和生存时间，次要结局包括住院率、住院时间以及开始透析后的死亡率。
仅当通过PFP和衰弱量表识别时，衰弱患者开始透析的时间显著缩短（衰弱患者为28.3个月，非衰弱患者为31.2个月，p = 0.028；衰弱患者为26.9个月，非衰弱患者为30.9个月，p = 0.038）。与非衰弱患者相比，PFP、衰弱量表和CFS工具显示衰弱患者的生存时间显著缩短（衰弱患者为26.8个月，非衰弱患者为30.6个月，p = 0.003）。衰弱与严重认知障碍密切相关，因为根据衰弱量表，45.5%的衰弱患者患有痴呆症，而非衰弱患者为15.1%（p<0.001）。然而，认知障碍并未显著影响开始透析的时间或生存时间。仅PRISMA-7识别出的衰弱患者的住院率和住院时间显著更高，衰弱患者的中位住院时间为9.15天，而非衰弱患者为6.37天（p = 0.044）。总体而言，37.5%的患者在研究随访期间未存活，衰弱患者的死亡率更高。
衰弱，主要通过PFP和衰弱量表评估时，是老年晚期CKD患者早期透析开始和生存时间缩短的重要预测因素。认知障碍虽然普遍存在，但并不能独立预测这些结局。应将定期衰弱筛查纳入CKD管理，以调整干预措施并改善患者结局。
