TY - JOUR T1 - Kidney function and prevalent and incident frailty. JF - Clin J Am Soc Nephrol Y1 - 2013 A1 - Dalrymple, Lorien S A1 - Katz, Ronit A1 - Rifkin, Dena E A1 - Siscovick, David A1 - Newman, Anne B A1 - Fried, Linda F A1 - Sarnak, Mark J A1 - Odden, Michelle C A1 - Shlipak, Michael G KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Biomarkers KW - Creatinine KW - Cross-Sectional Studies KW - Cystatin C KW - Fatigue KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Glomerular Filtration Rate KW - Humans KW - Incidence KW - Independent Living KW - Kidney KW - Kidney Diseases KW - Logistic Models KW - Male KW - Motor Activity KW - Multivariate Analysis KW - Muscle Weakness KW - Odds Ratio KW - Phenotype KW - Prevalence KW - Prospective Studies KW - Risk Factors KW - Time Factors KW - United States KW - Weight Loss AB -

BACKGROUND AND OBJECTIVES: Kidney disease is associated with physiologic changes that may predispose to frailty. This study sought to investigate whether lower levels of kidney function were associated with prevalent or incident frailty in Cardiovascular Health Study (CHS) participants.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: CHS enrolled community-dwelling adults age ≥65 years between 1989-1990 and 1992-1993. To examine prevalent frailty, included were 4150 participants without stroke, Parkinson disease, prescribed medications for Alzheimer disease or depression, or severely impaired cognition. To examine incident frailty, included were a subset of 3459 participants without baseline frailty or development of exclusion criteria during follow-up. The primary predictor was estimated GFR (eGFR) calculated using serum cystatin C (eGFR(cys)). Secondary analyses examined eGFR using serum creatinine (eGFR(SCr)). Outcomes were prevalent frailty and incident frailty at 4 years of follow-up. Frailty was ascertained on the basis of weight loss, exhaustion, weakness, slowness, and low physical activity.

RESULTS: The mean age was 75 years and the median eGFR(cys) was 73 ml/min per 1.73 m(2). Among participants with an eGFR(cys) <45 ml/min per 1.73 m(2), 24% had prevalent frailty. In multivariable analysis and compared with eGFR(cys) ≥90 ml/min per 1.73 m(2), eGFR(cys) categories of 45-59 (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.17 to 2.75) and 15-44 (OR, 2.87; 95% CI, 1.72 to 4.77) were associated with higher odds of frailty, whereas 60-75 (OR, 1.14; 95% CI, 0.76 to 1.70) was not. In multivariable analysis, eGFR(cys) categories of 60-75 (incidence rate ratio [IRR], 1.72; 95% CI, 1.07 to 2.75) and 15-44 (IRR, 2.28; 95% CI, 1.23 to 4.22) were associated with higher incidence of frailty whereas 45-59 (IRR, 1.53; 95% CI, 0.90 to 2.60) was not. Lower levels of eGFR(SCr) were not associated with higher risk of prevalent or incident frailty.

CONCLUSIONS: In community-dwelling elders, lower eGFR(cys) was associated with a higher risk of prevalent and incident frailty whereas lower eGFR(SCr) was not. These findings highlight the importance of considering non-GFR determinants of kidney function.

VL - 8 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24178972?dopt=Abstract ER -