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. 2024 Aug;56(8):2725-2731.
doi: 10.1007/s11255-024-03985-y. Epub 2024 Mar 18.

Phosphate is associated with frailty in older patients with chronic kidney disease not on dialysis

Mariana P Veloso  1 , Venceslau A Coelho  2 , Nigar Sekercioglu  3   4 , Rosa M A Moyses  1 , Rosilene M Elias  5   6
Affiliations

Phosphate is associated with frailty in older patients with chronic kidney disease not on dialysis

Mariana P Veloso et al. Int Urol Nephrol. 2024 Aug.

Abstract

Purpose: Frailty is common in older patients with chronic kidney disease (CKD) and has been considered an independent risk factor for adverse clinical outcomes in this population. CKD-associated mineral and bone metabolism (CKD-MBD) increases energy expenditure and causes malnutrition and inflammation leading to frailty. We investigated whether CKD-MBD markers and energy metabolism are associated with frailty in patients with advanced CKD on conservative management.

Methods: In this cross-sectional study, we investigated factors associated with frailty in a sample of 75 patients ≥ 65 years, with stage 4 or 5 CKD. Collected data included age, sex, body mass index, physical activity status, educational level, Charlson Comorbidity Index, and laboratory markers. Frailty was evaluated according to Fried's classification.

Results: Frailty was observed in 51.3% and pre-frailty in 47.3%. The frail population was significantly older, with a high proportion of females, more inactive, had lower educational levels, spent a long time sitting throughout the day, and had higher phosphate and fibroblast growth factor 21 (FGF-21). In the multivariate logistic analysis age (odds ratio 1.13, p = 0.026) and phosphate (odds ratio 3.38, p = 0.021) remained independently associated with frailty.

Conclusion: Serum phosphate seems to be a toxin associated with the frailty phenotype in older patients with CKD. Whether strategies to decrease serum phosphate would reduce the risk of frailty in this population deserves further evaluation.

Keywords: Conservative management; Fried’ criteria; Older.

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