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A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease

BACKGROUND: Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialys...

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Autores principales: King, Shannon J., Reid, Natasha, Brown, Sarah J., Brodie, Lucinda J., Sia, Aaron D. H., Chatfield, Mark D., Francis, Ross S., Peel, Nancye M., Gordon, Emily H., Hubbard, Ruth E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10580596/
https://www.ncbi.nlm.nih.gov/pubmed/37845618
http://dx.doi.org/10.1186/s12877-023-04365-4
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author King, Shannon J.
Reid, Natasha
Brown, Sarah J.
Brodie, Lucinda J.
Sia, Aaron D. H.
Chatfield, Mark D.
Francis, Ross S.
Peel, Nancye M.
Gordon, Emily H.
Hubbard, Ruth E.
author_facet King, Shannon J.
Reid, Natasha
Brown, Sarah J.
Brodie, Lucinda J.
Sia, Aaron D. H.
Chatfield, Mark D.
Francis, Ross S.
Peel, Nancye M.
Gordon, Emily H.
Hubbard, Ruth E.
author_sort King, Shannon J.
collection PubMed
description BACKGROUND: Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality. METHODS: Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m(2) were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records. RESULTS: Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI. CONCLUSIONS: Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-04365-4.
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spelling pubmed-105805962023-10-18 A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease King, Shannon J. Reid, Natasha Brown, Sarah J. Brodie, Lucinda J. Sia, Aaron D. H. Chatfield, Mark D. Francis, Ross S. Peel, Nancye M. Gordon, Emily H. Hubbard, Ruth E. BMC Geriatr Research BACKGROUND: Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality. METHODS: Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m(2) were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records. RESULTS: Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI. CONCLUSIONS: Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-04365-4. BioMed Central 2023-10-16 /pmc/articles/PMC10580596/ /pubmed/37845618 http://dx.doi.org/10.1186/s12877-023-04365-4 Text en © Crown 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
King, Shannon J.
Reid, Natasha
Brown, Sarah J.
Brodie, Lucinda J.
Sia, Aaron D. H.
Chatfield, Mark D.
Francis, Ross S.
Peel, Nancye M.
Gordon, Emily H.
Hubbard, Ruth E.
A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title_full A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title_fullStr A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title_full_unstemmed A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title_short A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
title_sort prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10580596/
https://www.ncbi.nlm.nih.gov/pubmed/37845618
http://dx.doi.org/10.1186/s12877-023-04365-4
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