Frailty as a Novel Predictor of Mortality and Hospitalization in Individuals of All Ages Undergoing Hemodialysis

Journal of the American Geriatrics Society - Tập 61 Số 6 - Trang 896-901 - 2013
Mara McAdams‐DeMarco1,2, Andrew Law1,2, Megan L. Salter1,2, Brian J. Boyarsky2, Luis Giménez3,4,5, Bernard G. Jaar1,3,4,5, Jeremy Walston6, Dorry L. Segev1,2
1Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
2Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
3Dialysis Program, Good Samaritan Hospital, Baltimore, Maryland
4Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
5Nephrology Center of Maryland, Baltimore, Maryland
6Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Tóm tắt

ObjectivesTo quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization.DesignProspective cohort study.SettingSingle hemodialysis center in Baltimore, Maryland.ParticipantsOne hundred forty‐six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012.MeasurementsFrailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations.ResultsAt enrollment, 50.0% of older (≥65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three‐year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02–7.07, P = .046) and 2.6 times (95% CI = 1.04–6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0–3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49–1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00–2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants.ConclusionsAdults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community‐dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations.

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Journal of the American Geriatrics Society

Tập 61 Số 6

896-901

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