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Multicenter Study
. 2013 Dec;8(12):2091-9.
doi: 10.2215/CJN.02870313. Epub 2013 Oct 31.

Kidney function and prevalent and incident frailty

Lorien S Dalrymple  1 , Ronit Katz, Dena E Rifkin, David Siscovick, Anne B Newman, Linda F Fried, Mark J Sarnak, Michelle C Odden, Michael G Shlipak
Affiliations
Multicenter Study

Kidney function and prevalent and incident frailty

Lorien S Dalrymple et al. Clin J Am Soc Nephrol. 2013 Dec.

Abstract

Background and objectives: Kidney disease is associated with physiologic changes that may predispose to frailty. This study sought to investigate whether lower levels of kidney function were associated with prevalent or incident frailty in Cardiovascular Health Study (CHS) participants.

Design, setting, participants, & measurements: CHS enrolled community-dwelling adults age ≥65 years between 1989-1990 and 1992-1993. To examine prevalent frailty, included were 4150 participants without stroke, Parkinson disease, prescribed medications for Alzheimer disease or depression, or severely impaired cognition. To examine incident frailty, included were a subset of 3459 participants without baseline frailty or development of exclusion criteria during follow-up. The primary predictor was estimated GFR (eGFR) calculated using serum cystatin C (eGFR(cys)). Secondary analyses examined eGFR using serum creatinine (eGFR(SCr)). Outcomes were prevalent frailty and incident frailty at 4 years of follow-up. Frailty was ascertained on the basis of weight loss, exhaustion, weakness, slowness, and low physical activity.

Results: The mean age was 75 years and the median eGFR(cys) was 73 ml/min per 1.73 m(2). Among participants with an eGFR(cys) <45 ml/min per 1.73 m(2), 24% had prevalent frailty. In multivariable analysis and compared with eGFR(cys) ≥90 ml/min per 1.73 m(2), eGFR(cys) categories of 45-59 (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.17 to 2.75) and 15-44 (OR, 2.87; 95% CI, 1.72 to 4.77) were associated with higher odds of frailty, whereas 60-75 (OR, 1.14; 95% CI, 0.76 to 1.70) was not. In multivariable analysis, eGFR(cys) categories of 60-75 (incidence rate ratio [IRR], 1.72; 95% CI, 1.07 to 2.75) and 15-44 (IRR, 2.28; 95% CI, 1.23 to 4.22) were associated with higher incidence of frailty whereas 45-59 (IRR, 1.53; 95% CI, 0.90 to 2.60) was not. Lower levels of eGFR(SCr) were not associated with higher risk of prevalent or incident frailty.

Conclusions: In community-dwelling elders, lower eGFR(cys) was associated with a higher risk of prevalent and incident frailty whereas lower eGFR(SCr) was not. These findings highlight the importance of considering non-GFR determinants of kidney function.

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Figures

Figure 1.
Figure 1.
Cohort selection. The selection of Cardiovascular Health Study participants to examine the association between kidney function and prevalent frailty. eGFRcys, estimated GFR using cystatin C; MMSE, Mini-Mental State Examination; 3MSE, modified Mini-Mental State Examination.
Figure 2.
Figure 2.
Prevalence of frailty by level of kidney function. (A) Prevalence of frailty by categories of estimated GFR using cystatin C (eGFRcys). (B) Prevalence of frailty by categories of estimated GFR using cystatin C stratified by sex.
See this image and copyright information in PMC

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