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Frailty common among patients on dialysis, associated with adverse outcomes, researchers find

Monday, November 12 2007 | Comments

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What's This? Frailty appears common among patients on dialysis and may be associated with greater risk of death or hospitalization, study data indicate.

Researchers examined data from a cohort of 2,275 adults who participated in the DMMS Wave 2 study to determine the prevalence and predictors of frailty among patients on dialysis, as well as to determine the degree to which frailty is associated with adverse outcomes. Frailty was comprised of a composite of poor self-reported physical functioning, exhaustion/fatigue, low physical activity, and undernutrition.

Results showed that two-thirds of the study population met the criteria for frailty. Although older age was related to frailty, 44% of patients aged less than 40 years and more than half of patients aged 40 to 50 years were deemed frail.

Frailty was associated with female sex; body mass index <19 kg/m2; comorbid diabetes, stroke, or serum albumin concentrations <3.5 g/dL; and hemodialysis vs peritoneal dialysis.

In multivariate analysis that adjusted for age, sex, and other factors, frailty was strongly associated with mortality (HR, 2.24; 95% CI, 1.60-3.15) and hospitalization for any reason (HR, 1.56; 95% CI, 1.36-1.79).

"Identification of frailty early in the course of end-stage renal disease could lead to earlier or more intensive interventions to slow function decline, which might reduce the need for hospitalization and reduce the risk for death among dialysis patients," the authors concluded. "Although we should not ignore dialysis dosage or the other laboratory parameters in ESRD, until we are able to delay or prevent pervasive functional decline, we cannot consider that we have delivered 'adequate' dialysis."

These findings by Johansen KL, et al. were published online Oct. 17 ahead of print in the Journal of the American Society of Nephrology.

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