Prospective Study of the Association Between Frailty and Health Care Utilization in Patients With Advanced CKD

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2025-06-01 DOI:10.1016/j.ekir.2025.03.032

Alice L. Kennard , Alice M. Richardson , Suzanne Rainsford , Kelly L. Hamilton , Nicholas J. Glasgow , Kate L. Pumpa , Angela M. Douglas , Girish S. Talaulikar

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引用次数: 0

Abstract

Introduction

Frailty likely contributes to disproportionate health care utilization among people living with chronic kidney disease (CKD) and undergoing hemodialysis (HD); but this is poorly captured in nephrology clinical and research practice. We examined Fried frailty phenotype among participants with CKD or on HD and explored associations with health care utilization. We examined frailty transitions in relation to hospitalization.

Methods

We conducted a prospective observational single-center study of patients with advanced CKD or undergoing HD. Frailty was assessed at baseline, 6 and 12 months. Demographic and clinical data, including comorbid burden, disability, and laboratory parameters were recorded. Data linkage with tertiary hospital captured emergency department (ED) presentations, hospital admissions, and days of hospital stay, excluding admissions for maintenance HD. Negative binomial regression was used to model health care utilization patterns. Frailty progression over study follow-up was described using Cox proportional hazards modelling.

Results

Among 256 participants, frailty (36.3%) and prefrailty (46.5%) were highly prevalent. Frailty independently predicted ED presentation (incidence rate ratio [IRR]: 1.25, 95% confidence interval [CI]: 1.09–1.43), hospitalization (IRR: 1.22, 95% CI: 1.08–1.37), and total days of hospitalization (IRR: 1.29, 95% CI: 1.06–1.57) independent of demographics, comorbidity, disability, and inflammation. The median occurrence of hospitalization events was 152 days (interquartile range [IQR]: 44–251) after enrolment, suggesting a window of opportunity where frailty recognition might prompt targeted intervention to prevent frailty-related sequelae. Frailty was highly dynamic; frailty progression was not associated with hospitalization or length of stay.

Conclusion

Frailty is a major contributor to excess health care utilization among people with kidney disease. Recognition of the prognostic implications of frailty might allow timely introduction of interventions to improve patient outcomes.

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晚期CKD患者虚弱与医疗保健利用关系的前瞻性研究

在患有慢性肾脏疾病（CKD）和接受血液透析（HD）的人群中，虚弱可能导致不成比例的医疗保健利用；但在肾脏学临床和研究实践中，这一点很少被捕捉到。我们检查了CKD或HD患者的Fried脆弱表型，并探讨了其与医疗保健利用的关系。我们研究了与住院治疗相关的虚弱转变。方法：我们对晚期CKD或HD患者进行了一项前瞻性观察性单中心研究。在基线、6个月和12个月时评估虚弱程度。记录人口统计学和临床数据，包括合并症负担、残疾和实验室参数。与三级医院的数据链接包括急诊科（ED）报告、住院情况和住院天数，不包括维护性HD住院情况。采用负二项回归对卫生保健利用模式进行建模。使用Cox比例风险模型描述研究随访期间的虚弱进展。结果256名参与者中，体弱多病占36.3%，体弱多病占46.5%。虚弱独立预测ED表现（发病率比[IRR]: 1.25, 95%可信区间[CI]: 1.09-1.43）、住院（IRR: 1.22, 95% CI: 1.08-1.37）和住院总天数（IRR: 1.29, 95% CI: 1.06-1.57），独立于人口统计学、合并症、残疾和炎症。入组后住院事件发生的中位数为152天（四分位数间距[IQR]: 44-251），提示虚弱识别可能提示有针对性的干预措施，以预防虚弱相关的后遗症。脆弱是高度动态的；虚弱的进展与住院或住院时间无关。结论虚弱是肾病患者过度利用医疗保健服务的主要原因。认识到虚弱的预后影响可能允许及时引入干预措施以改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.