Gaube Sophie, Clark David, Cooper Dylan, Nadeau-Fredette Annie-Claire, Vinson Amanda, Tennankore Karthik
Dalhousie University, Halifax, NS, Canada.
Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Perit Dial Int. 2025 Mar;45(2):74-83. doi: 10.1177/08968608241274095. Epub 2024 Sep 5.
Frailty is associated with poor outcomes for patients on dialysis; however, dedicated studies among incident peritoneal dialysis (PD) patients are lacking. This study aims to determine the association between frailty and mortality/transfer to hemodialysis (HD) among incident PD patients and identify whether dialysis modality (PD vs. HD) modifies the association of frailty and mortality following dialysis initiation.
A single center retrospective cohort of incident PD and HD patients was analyzed from 2009 to 2020 (last follow-up December 2021). The first version of the clinical frailty scale (CFS) ranging from 1, very fit, to 7, severely frail, was used to characterize patient frailty at dialysis initiation. Time to death/transfer to HD was analyzed using multivariable Cox Survival analyses. Patients were censored at transplant/last follow-up. Dialysis modality was evaluated as a potential effect modifier on the impact of frailty on mortality.
Of 253 patients who initiated PD, 182 had completed CFS scores. Mean age at dialysis initiation was 63 ± 13 years and mean CFS score was 3 ± 1. There were 42 deaths and 69 instances of transfer to HD over 379 patient-years at risk. Vulnerable/frail patients (CFS ≥ 4) had a two-fold increase in the adjusted relative hazard for death/transfer to HD (HR 2.04, 95% CI [1.10-3.77]). Incident dialysis modality did not modify the association between frailty and mortality.
A higher severity of frailty at PD initiation is associated with both mortality/transfer to HD and mortality alone, and the association between frailty and mortality is not modified by dialysis modality.
衰弱与透析患者的不良预后相关；然而，针对新开始腹膜透析（PD）患者的专门研究尚缺乏。本研究旨在确定新开始PD患者中衰弱与死亡率/转为血液透析（HD）之间的关联，并确定透析方式（PD与HD）是否会改变透析开始后衰弱与死亡率之间的关联。
分析了2009年至2020年（最后随访时间为2021年12月）新开始PD和HD患者的单中心回顾性队列。使用临床衰弱量表（CFS）的第一版，范围从1（非常健康）到7（严重衰弱），来描述透析开始时患者的衰弱情况。使用多变量Cox生存分析来分析死亡/转为HD的时间。患者在移植/最后随访时进行截尾。将透析方式评估为衰弱对死亡率影响的潜在效应修饰因素。
在253例开始PD的患者中，182例有完整的CFS评分。透析开始时的平均年龄为63±13岁，平均CFS评分为3±1。在379患者-年的风险期内，有42例死亡和69例转为HD。脆弱/衰弱患者（CFS≥4）死亡/转为HD的调整后相对风险增加了两倍（HR 2.04，95%CI[1.10 - 3.77]）。新开始的透析方式并未改变衰弱与死亡率之间的关联。
PD开始时较高的衰弱严重程度与死亡率/转为HD以及单独的死亡率均相关，且衰弱与死亡率之间的关联不受透析方式的影响。
