Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Feb;69(2):228-236.
doi: 10.1053/j.ajkd.2016.08.034. Epub 2016 Nov 22.

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study

Shoshana H Ballew  1 , Yan Chen  2 , Natalie R Daya  2 , Job G Godino  3 , B Gwen Windham  4 , Mara McAdams-DeMarco  2 , Josef Coresh  2 , Elizabeth Selvin  2 , Morgan E Grams  5
Affiliations
Observational Study

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study

Shoshana H Ballew et al. Am J Kidney Dis. 2017 Feb.

Abstract

Background: Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals.

Study design: Observational study.

Setting & participants: 4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013).

Predictors: Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio.

Outcome: Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity).

Results: 341 (7%) participants were classified as frail, 1,475 (30%) had eGFRcr<60mL/min/1.73m2, 2,480 (50%) had eGFRcys<60mL/min/1.73m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of eGFRcr and eGFRcys<60mL/min/1.73m2 were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcr and a strong association with eGFRcys and albumin-creatinine ratio. Frail individuals with eGFRcr of 60 to <75mL/min/1.73m2 were frequently reclassified to lower eGFR categories using eGFRcys (49% to 45-<60, 32% to 30-<45, and 3% to <30mL/min/1.73m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants).

Limitations: Cross-sectional study design.

Conclusions: Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFRcys versus eGFRcr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.

Keywords: Frailty; albuminuria; biomarker; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); frail; geriatric; older adults; polypharmacy; prefrail; reduced kidney function; serum creatinine; serum cystatin C; urine albumin.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Adjusted prevalence ratios for frailty status by eGFR
Prevalence ratios adjusted for age, sex, race-center, education, smoking status, alcohol consumption, BMI, systolic blood pressure, anemia [hemoglobin], inflammation [C-reactive protein], cardiovascular disease [history of coronary heart disease, peripheral artery disease, heart failure, stroke], diabetes, hypertension medications use, statin medication use) and either ACR (log-transformed).
Figure 2
Figure 2. Adjusted prevalence ratios for frailty status by ACR
Prevalence ratios adjusted for age, sex, race-center, education, smoking status, alcohol consumption, BMI, systolic blood pressure, anemia [hemoglobin], inflammation [C-reactive protein], cardiovascular disease [history of coronary heart disease, peripheral artery disease, heart failure, stroke], diabetes, hypertension medications use, statin medication use) and eGFR.
Figure 3
Figure 3. Demographically-adjusted prevalence ratios (95% CIs) of frailty by eGFRcr (A) or eGFRcys (B) and albuminuria category
*p≤.05; **p≤.01; ***p≤.001
See this image and copyright information in PMC

References

    1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences. 2001;56(3):M146–156. - PubMed
    1. Bandeen-Roche K, Seplaki CL, Huang J, et al. Frailty in Older Adults: A Nationally Representative Profile in the United States. The journals of gerontology. Series A, Biological sciences and medical sciences. 2015;70(11):1427–1434. - PMC - PubMed
    1. Zaslavsky O, Cochrane BB, Thompson HJ, Woods NF, Herting JR, LaCroix A. Frailty: a review of the first decade of research. Biological research for nursing. 2013;15(4):422–432. - PubMed
    1. Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing research reviews. 2013;12(2):719–736. - PubMed
    1. Hubbard RE, O’Mahony MS, Woodhouse KW. Medication prescribing in frail older people. European journal of clinical pharmacology. 2013;69(3):319–326. - PubMed

Publication types