Huang Chiung-Ying, Tsao Hsiao-Mei, Liang Shu-Ling, Lai Tai-Shuan, Chen Yung-Ming
Department of Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan.
Aging (Albany NY). 2025 Apr 15;17(4):1060-1072. doi: 10.18632/aging.206239.
Frailty predicts adverse clinical outcomes in older adults. Its prognoses in individuals with specific illnesses have not been fully explored. This study aimed to investigate the impact of frailty by using a semiautomated instrument in patients with advanced chronic kidney disease (CKD).
In this prospective study, patients with CKD3b-5 before dialysis and aged ≥55 years with a clinical frailty scale of ≤5 were enrolled. Frailty was assessed by three commonly-used evaluation tools, i.e., Fried's frailty phenotype, Study of Osteoporotic Fractures (SOF) index, and Frailty index of 80 risk variables (FI80) incorporated in a semiautomated platform. Logistic regression, Kaplan-Meier analysis, and Cox proportional hazards models were used to analyze the predictors for frailty and the impact of frailty on composite outcomes of dialysis and overall death. Among 315 patients, the mean age was 73.1 years, and the estimated glomerular filtration rate was 22.2 ml/min/1.73 m. The prevalence of frailty was 6.2% by Fried's frailty phenotype, 0.6% by SOF index, and 26.7% by FI80. Logistic regression analysis showed that age, but not CKD severity or proteinuria, was the most consistent predictor for frailty across the three evaluative tools. During an average follow-up period of 1.7 years, the incidences of kidney failure resulting in dialysis, overall death, or hospital admission were 10.5, 0.6, and 15.2 per 1,000 patient-month, respectively. Kaplan-Meier analysis revealed that frail patients identified by FI80 exhibited worse composite outcomes than their prefrail and robust counterparts (log-rank test, = 0.01). Multivariate Cox models confirmed that frailty defined by FI80 predicted adverse composite outcomes (HR 3.51, 95% CI: 1.20, 10.22).
Frailty is common among CKD patients, and its prevalence increases with age and disease advancement. The frailty status identified by the FI80 effectively predicted end-stage kidney disease or death in patients with advanced CKD.
衰弱可预测老年人的不良临床结局。其在患有特定疾病个体中的预后尚未得到充分研究。本研究旨在使用半自动工具调查衰弱对晚期慢性肾脏病（CKD）患者的影响。
在这项前瞻性研究中，纳入了透析前CKD3b - 5期、年龄≥55岁且临床衰弱量表评分≤5的患者。通过三种常用评估工具评估衰弱，即Fried衰弱表型、骨质疏松性骨折研究（SOF）指数以及纳入半自动平台的80个风险变量的衰弱指数（FI80）。采用逻辑回归、Kaplan - Meier分析和Cox比例风险模型分析衰弱的预测因素以及衰弱对透析和全因死亡复合结局的影响。315例患者中，平均年龄为73.1岁，估计肾小球滤过率为22.2 ml/min/1.73 m²。根据Fried衰弱表型，衰弱患病率为6.2%；根据SOF指数为0.6%；根据FI80为26.7%。逻辑回归分析表明，年龄而非CKD严重程度或蛋白尿是三种评估工具中最一致的衰弱预测因素。在平均1.7年的随访期内，每1000患者 - 月因肾衰竭导致透析、全因死亡或住院的发生率分别为10.5、0.6和15.2。Kaplan - Meier分析显示，FI80识别出的衰弱患者比其衰弱前期和非衰弱患者的复合结局更差（对数秩检验，P = 0.01）。多变量Cox模型证实，FI80定义的衰弱可预测不良复合结局（风险比3.51，95%置信区间：1.20，10.22）。
衰弱在CKD患者中很常见，其患病率随年龄和疾病进展而增加。FI80识别的衰弱状态可有效预测晚期CKD患者的终末期肾病或死亡。
