Kennard Alice L, Richardson Alice M, Rainsford Suzanne, Hamilton Kelly L, Glasgow Nicholas J, Pumpa Kate L, Douglas Angela M, Talaulikar Girish S
College of Health and Medicine, Australian National University, Canberra, Australia.
Department of Renal Medicine, Canberra Health Services, Canberra, Australia.
Kidney Int Rep. 2025 Mar 27;10(6):1694-1710. doi: 10.1016/j.ekir.2025.03.032. eCollection 2025 Jun.
Frailty likely contributes to disproportionate health care utilization among people living with chronic kidney disease (CKD) and undergoing hemodialysis (HD); but this is poorly captured in nephrology clinical and research practice. We examined Fried frailty phenotype among participants with CKD or on HD and explored associations with health care utilization. We examined frailty transitions in relation to hospitalization.
We conducted a prospective observational single-center study of patients with advanced CKD or undergoing HD. Frailty was assessed at baseline, 6 and 12 months. Demographic and clinical data, including comorbid burden, disability, and laboratory parameters were recorded. Data linkage with tertiary hospital captured emergency department (ED) presentations, hospital admissions, and days of hospital stay, excluding admissions for maintenance HD. Negative binomial regression was used to model health care utilization patterns. Frailty progression over study follow-up was described using Cox proportional hazards modelling.
Among 256 participants, frailty (36.3%) and prefrailty (46.5%) were highly prevalent. Frailty independently predicted ED presentation (incidence rate ratio [IRR]: 1.25, 95% confidence interval [CI]: 1.09-1.43), hospitalization (IRR: 1.22, 95% CI: 1.08-1.37), and total days of hospitalization (IRR: 1.29, 95% CI: 1.06-1.57) independent of demographics, comorbidity, disability, and inflammation. The median occurrence of hospitalization events was 152 days (interquartile range [IQR]: 44-251) after enrolment, suggesting a window of opportunity where frailty recognition might prompt targeted intervention to prevent frailty-related sequelae. Frailty was highly dynamic; frailty progression was not associated with hospitalization or length of stay.
Frailty is a major contributor to excess health care utilization among people with kidney disease. Recognition of the prognostic implications of frailty might allow timely introduction of interventions to improve patient outcomes.
衰弱可能导致慢性肾脏病（CKD）患者及接受血液透析（HD）的患者医疗保健利用率过高；但在肾脏病临床和研究实践中，这一点并未得到充分体现。我们研究了CKD患者或HD患者的弗里德衰弱表型，并探讨了其与医疗保健利用率的关联。我们还研究了与住院相关的衰弱转变情况。
我们对晚期CKD患者或接受HD的患者进行了一项前瞻性观察性单中心研究。在基线、6个月和12个月时评估衰弱情况。记录人口统计学和临床数据，包括共病负担、残疾情况和实验室参数。与三级医院的数据链接获取了急诊科就诊情况、住院情况和住院天数，但不包括维持性HD的住院情况。使用负二项回归对医疗保健利用模式进行建模。使用Cox比例风险模型描述研究随访期间的衰弱进展情况。
在256名参与者中，衰弱（36.3%）和衰弱前期（46.5%）非常普遍。衰弱独立预测急诊科就诊（发病率比[IRR]：1.25，95%置信区间[CI]：1.09 - 1.43）、住院（IRR：1.22，95% CI：1.08 - 1.37）以及总住院天数（IRR：1.29，95% CI：1.06 - 1.57），且不受人口统计学、共病、残疾和炎症的影响。入组后住院事件的中位发生时间为152天（四分位间距[IQR]：44 - 251），这表明存在一个机会窗口，在此期间识别衰弱可能促使进行有针对性的干预，以预防与衰弱相关的后遗症。衰弱具有高度动态性；衰弱进展与住院或住院时间无关。
衰弱是导致肾病患者医疗保健利用率过高的主要因素。认识到衰弱的预后意义可能有助于及时引入干预措施以改善患者预后。
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