Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population‐based cohort study. Issue 7 (5th April 2021)

• Record Type: Journal Article
• Authors: Lee, Szu‐Ying; Wang, Jui; Chao, Chia‐Ter; Chien, Kuo‐Liong; Huang, Jenq‐Wen
• Is Part Of: Diabetic medicine. Volume 38:Issue 7(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-04-05
• Subjects: chronic kidney disease -- cognitive impairment -- delirium -- diabetes mellitus -- diabetic kidney disease -- frail phenotype; Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14566
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under‐recognized complication of diabetes mellitus. Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear. Methods: From the longitudinal cohort of diabetes patients (LCDP) ( n = 840, 000) in Taiwan, we identified adults with DKD, dividing them into those without and with different severities of frailty based on a modified FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty‐associated risk of delirium/cognitive impairment, identified using approaches validated by others. Results: Totally 149, 145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0% and 1.3% did not have or had 1, 2 and >2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, co‐morbidities, medications and interventions, patients with DKD and 1, 2 and >2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2 and >2 items, hazard ratio 1.18, 1.26 and 1.30, 95% confidence interval 1.08–1.28, 1.14–1.39 and 1.10–1.55, respectively). For every FRAIL item increase, the associated risk rose by 9%. Conclusions: Frailty significantly increased the risk of delirium/cognitive impairment among patients with DKD. Frailty screening in these patients may assist in delirium risk stratification.