The Impact of Frailty on Prognosis in Elderly Hemodialysis Patients: A Prospective Cohort Study

Abstract

Purpose

To explore the impact of frailty on adverse outcomes in elderly hemodialysis (HD) patients.

Patients and Methods

An observational and prospective cohort study was conducted in elderly patients (≥60) with HD, with an average 12-month follow-up. Fried frailty phenotype (FFP) was used to define frailty. Negative binomial regression was used to estimate the impact of frailty on the incidence of emergency visits, hospitalizations, acute cardiovascular events, and falls within a year. Cox regression analysis was used to assess the influence of frailty on all-cause mortality in elderly HD patients.

Results

Our study enrolled 150 elderly HD patients, and the prevalence of frailty was 34.7%. After adjustment, frailty was independently associated with increased all-cause mortality [hazard ratio (HR)=4.10, 95% CI: 1.09–15.43, p=0.037] and emergency visits [incidence rate ratio (IRR)=2.78 95% CI: 1.70–4.60, p<0.001]. Gait speed was an independent risk factor for all-cause deaths (HR=5.56 95% CI: 1.41–22.00, p=0.014), emergency visits (IRR=2.52 95% CI: 1.48–4.33, p<0.001), and hospitalizations (IRR=2.24, 95% CI: 1.19–4.21, p=0.010) in elderly HD patients.

Conclusion

Frailty was an independent indicator of all-cause mortality and emergency visits in elderly patients with HD.

Keywords:

• elderly people
• frailty
• hemodialysis
• mortality
• emergency visits
• hospitalizations

Acknowledgments

The authors thank all patients, researchers and staff who were involved in the study.

Abbreviations

HD, hemodialysis; FFP, Fried frailty phenotype; HR, hazard ratio; IRR, incidence rate ratio; DM, diabetes; CHD, coronary heart disease; CPD, chronic pulmonary disease; CKD, chronic kidney diseases; ESRD, end stage renal disease; URR, urea reduction rate; BUN, blood urea nitrogen; MNA-SF, Mini-nutritional assessment-short form; IQR, interquartile range; WBC, white blood cells; TC, total  cholesterol; TG, triglycerides; TS, transferrin saturation; PTH, parathyroid hormone.

Data Sharing Statement

In order to protect the confidentiality of participants, the data are not publicly available. The data supporting the results of this study can be provided at the request of the corresponding author.

Ethics Approval and Informed Consent

The research protocol was in compliance with the Helsinki Declaration and approved by the Clinical Research Ethics Committee of the Beijing Friendship Hospital, Capital Medical University (Project number: 2019-P2-170-01). Before participating in the study, all patients signed the written informed consent form.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, agreed to the submitted journal, and agree to be accountable for all aspects of the work.

Disclosure

The authors report that there are no conflicts of interest in this work.