Frailty as a Novel Predictor of Mortality and Hospitalization in Individuals of All Ages Undergoing Hemodialysis. Issue 6 (27th May 2013)

• Record Type: Journal Article
• Authors: McAdams‐DeMarco, Mara A.; Law, Andrew; Salter, Megan L.; Boyarsky, Brian; Gimenez, Luis; Jaar, Bernard G.; Walston, Jeremy D.; Segev, Dorry L.
• Is Part Of: Journal of the American Geriatrics Society. Volume 61:Issue 6(2013:Jun.)
• Page Start: 896
• Page End: 901
• Publication Date: 2013-05-27
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12266
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12266-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12266-sec-0001" sec-type="section"> <title>Objectives</title> <p>To 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.</p> </sec> <sec id="jgs12266-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="jgs12266-sec-0003" sec-type="section"> <title>Setting</title> <p>Single hemodialysis center in Baltimore, Maryland.</p> </sec> <sec id="jgs12266-sec-0004" sec-type="section"> <title>Participants</title> <p>One hundred forty‐six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012.</p> </sec> <sec id="jgs12266-sec-0005" sec-type="section"> <title>Measurements</title> <p>Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations.</p> </sec> <sec id="jgs12266-sec-0006" sec-type="section"> <title>Results</title> <p>At 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, <italic>P </italic>=<italic> </italic>.046) and 2.6 times (95% CI = 1.04–6.49, <italic>P </italic>=<italic> </italic>.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, <italic>P </italic>=<italic> </italic>.21), frailty was associated with 1.4 times (95% CI = 1.00–2.03, <italic>P </italic>=<italic> </italic>.049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction <italic>P </italic>=<italic> </italic>.64) and hospitalizations (<italic>P </italic>=<italic> </italic>.14) did not differ between older and younger participants.</p> </sec> <sec id="jgs12266-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Adults 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.</p> </sec> </abstract>