Frailty in Older Patients Undergoing Hemodialysis and Its Association with All-Cause Mortality: A Prospective Cohort Study

Abstract

Purpose

The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality.

Participants and Methods

We enrolled a group of older adults (≥60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried’s definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses.

Results

The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886–19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA<26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before.

Conclusion

Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.

Keywords:

• frailty
• risk factors
• older adult
• hemodialysis
• mortality

Data Sharing Statement

The raw data supporting the findings of this study will be made available from the corresponding author upon reasonable request.

Ethics Statement and Informed Consent

The studies involving human participants were reviewed and approved by the Institutional Research Ethics Committee of Beijing Shijitan Hospital, Capital Medical University (Approval no. SJT2016-18), this approved protocol was also authorized by other joining hospitals as a general ethical document. All participants provided written informed consent by themselves or their legal guardians.

Consent for Publication

The authors obtained written informed consent to publish the participant’s related details in this study.

Acknowledgments

The authors acknowledged the tremendous assistance of the doctors and nurses in the dialysis centers at 11 hospitals in Beijing for their support and collaboration in this research.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This project was supported by grants from The Beijing Municipal Science & Technology Commission (No. Z161100002616005) and The capital health research and development of special (2022-2-2081). The funders had no role in study design, data collection, data analysis, decision to publish, and preparation of the manuscript.