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Clin J Am Soc Nephrol. 2016 Apr 7;11(4):626-32. doi: 10.2215/CJN.03710415. Epub 2016 Jan 20.

Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis.

Author information

1
Division of Nephrology and Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California; Kirsten.johansen@ucsf.edu.
2
Division of Nephrology, University of California, Davis, California; and.
3
Department of Epidemiology and Biostatistics, University of California, San Francisco, California;
4
Division of Nephrology and Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California;
5
Division of Nephrology, Stanford University School of Medicine, Stanford, California.

Abstract

BACKGROUND AND OBJECTIVES:

Frailty is common among patients on dialysis and increases vulnerability to dependency and death.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We examined the predictive ability of frailty on the basis of physical performance and self-reported function in participants of a US Renal Data System special study that enrolled a convenience sample of 771 prevalent patients on hemodialysis from 14 facilities in the Atlanta and northern California areas from 2009 to 2011. Performance-based frailty was assessed using direct measures of grip strength (weakness) and gait speed along with weight loss, exhaustion, and low physical activity; poor self-reported function was substituted for weakness and slow gait speed in the self-reported function-based definition. For both definitions, patients meeting three or more criteria were considered frail.

RESULTS:

The mean age of 762 patients included in analyses was 57.1±14.2 years old; 240 patients (31%) met the physical performance-based definition of frailty, and 396 (52%) met the self-reported function-based definition. There were 106 deaths during 1.7 (interquartile range, 1.4-2.4) years of follow-up. After adjusting for demographic and clinical characteristics, the hazard ratio (HR) for mortality for the performance-based definition (2.16; 95% confidence interval [95% CI], 1.41 to 3.29) was slightly higher than that of the self-reported function-based definition (HR, 1.93; 95% CI, 1.24 to 3.00). Patients who met the self-report-based definition but not the physical performance definition of frailty (n=192) were not at statistically significantly higher risk of mortality than those who were not frail by either definition (n=330; HR, 1.41; 95% CI, 0.81 to 2.45), but those who met both definitions of frailty (n=204) were at significantly higher risk (HR, 2.46; 95% CI, 1.51 to 4.01).

CONCLUSIONS:

Frailty, defined using either direct tests of physical performance or self-reported physical function, was associated with higher mortality among patients receiving hemodialysis. Future studies are needed to determine the utility of assessing frailty in clinical practice.

KEYWORDS:

ESRD; fatigue; follow-up studies; gait; geriatric nephrology; hand strength; health status indicators; hemodialysis; humans; physical fitness; survival

PMID:
26792529
PMCID:
PMC4822658
DOI:
10.2215/CJN.03710415
[Indexed for MEDLINE]
Free PMC Article

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