Int J Med Sci 2021; 18(14):3309-3317. doi:10.7150/ijms.51569

Research Paper

Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China

Wenjing Fu1,3, Aihua Zhang1, Lina Ma3,4, Linpei Jia1, Jagadish K Chhetri2,3, Piu Chan2,3,4✉

1. Department of Nephrology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
2. Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
3. Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
4. National Clinical Research Center for Geriatric Disorders, Beijing, China

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Citation:
Fu W, Zhang A, Ma L, Jia L, Chhetri JK, Chan P. Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China. Int J Med Sci 2021; 18(14):3309-3317. doi:10.7150/ijms.51569. Available from https://www.medsci.org/v18p3309.htm

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Abstract

Graphic abstract

Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients.

Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status.

Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD.

Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.

Keywords: Frail, Hemodialysis, Aging, Ultrafiltration volume, Mortality, Chinese