The Prevalence, Association, and Clinical Outcomes of Frailty in Maintenance Dialysis Patients

Abstract

Objective: To investigate the clinical implications of frailty in chronic kidney disease patients undergoing maintenance hemodialysis and chronic peritoneal dialysis. Design: In this prospective study, all of the participants completed the Short Form of the Kidney Disease Quality of Life questionnaire, Korean version, to determine their frailty phenotype. We also obtained blood chemistry and demographic data at enrollment. Data regarding the history of hospitalization and death were collected during the follow- up period. Subjects: We recruited 1,658 patients (1,255 maintenance hemodialysis and 403 chronic peritoneal dialysis) from multidialysis units (n 5 27). We excluded patients who had been hospitalized in the previous 3 months. Main Outcome Measures: Hospitalization and survival rate during study period. Results: The participants'mean agewas 55.2 +/- 11.9 years old, and 55.2% weremale. Among the participants, 34.8% were rated as frail and 45.7% as prefrail. Multivariate analysis demonstrated significant associations of frailty with age, comorbidity, disability, unemployment, higher body mass index, and a lower educational level. During the follow- up period (median 17.1 months), 608 patients (79 not frail, 250 prefrail, and 279 frail) were hospitalized, and 87 patients (10 not frail, 24 prefrail, and 53 frail) died (P <.001). Frailty was associated with hospitalization (adjusted hazard ratio, 1.80; 95% confidence interval: 1.38-2.36) and mortality (hazard ratio, 2.37, 95% confidence interval: 1.11-5.02). Conclusion: The frailty phenotype was common even in, prevalent end- stage renal disease patients on dialysis, and was significantly associated with higher rates of hospitalization and mortality. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY- NC- ND license