TY - JOUR
T1 - Frailty phenotype and multi-domain impairments in older patients with chronic kidney disease
AU - Vettoretti, Simone
AU - Caldiroli, Lara
AU - Porata, Giulia
AU - Vezza, Carlotta
AU - Cesari, Matteo
AU - Messa, Piergiorgio
PY - 2020/9/29
Y1 - 2020/9/29
N2 - Background: Older subjects with chronic kidney disease (CKD) are often affected by multiple geriatric impairments that may benefit from a comprehensive geriatric assessment (CGA). However, ordinary execution of CGA in all these individuals would be unaffordable. We evaluated if Frailty Phenotype (FP) could identify older CKD-patients that may benefit the most from a CGA. Methods: We evaluated 112 CKD patients not yet on dialysis (age ≥ 65 years, eGFR < 45 ml/min). FP was defined according to the criteria proposed by Fried and co-authors. CGA evaluated four domains (nutrition, physical performance, cognition and depression). Malnutrition was defined in accordance to Malnutrition-Inflammation Score (MIS) and/or by the presence of Protein Energy Wasting syndrome (PEW). Physical performance was evaluated using Short Physical Performance Battery (SPPB) and handgrip strength. Cognitive status was assessed by using Mini Mental State Examination (MMSE) and Clock Drawing Test. Mood was investigated with Geriatric Depression Scale (GDS). Results: Average age of our cohort was 80 ± 6 years and mean eGFR 24 ± 11 ml/min/1.73 m2. Prevalence of frailty was 45%. Frail patients (F-CKD) had higher prevalence of malnutrition (58 vs 29%, p = 0.0005), physical impairment (100% vs 78%; p < 0.0001), cognitive dysfunction (83% vs 37%; p < 0.0001) and depression (50% vs 21%; p < 0.001) compared to robust ones (NF-CKD). Moreover, F-CKD patients had higher probability to have > 2 impaired domains (83% sensitivity and 76% specificity) respect to NF-CKD individuals. Conclusions: FP is a reliable screening tool to identify older CKD-patients that may benefit from a CGA.
AB - Background: Older subjects with chronic kidney disease (CKD) are often affected by multiple geriatric impairments that may benefit from a comprehensive geriatric assessment (CGA). However, ordinary execution of CGA in all these individuals would be unaffordable. We evaluated if Frailty Phenotype (FP) could identify older CKD-patients that may benefit the most from a CGA. Methods: We evaluated 112 CKD patients not yet on dialysis (age ≥ 65 years, eGFR < 45 ml/min). FP was defined according to the criteria proposed by Fried and co-authors. CGA evaluated four domains (nutrition, physical performance, cognition and depression). Malnutrition was defined in accordance to Malnutrition-Inflammation Score (MIS) and/or by the presence of Protein Energy Wasting syndrome (PEW). Physical performance was evaluated using Short Physical Performance Battery (SPPB) and handgrip strength. Cognitive status was assessed by using Mini Mental State Examination (MMSE) and Clock Drawing Test. Mood was investigated with Geriatric Depression Scale (GDS). Results: Average age of our cohort was 80 ± 6 years and mean eGFR 24 ± 11 ml/min/1.73 m2. Prevalence of frailty was 45%. Frail patients (F-CKD) had higher prevalence of malnutrition (58 vs 29%, p = 0.0005), physical impairment (100% vs 78%; p < 0.0001), cognitive dysfunction (83% vs 37%; p < 0.0001) and depression (50% vs 21%; p < 0.001) compared to robust ones (NF-CKD). Moreover, F-CKD patients had higher probability to have > 2 impaired domains (83% sensitivity and 76% specificity) respect to NF-CKD individuals. Conclusions: FP is a reliable screening tool to identify older CKD-patients that may benefit from a CGA.
KW - Chronic kidney disease
KW - Comprehensive geriatric assessment
KW - Frailty phenotype
KW - Malnutrition
KW - Physical performance
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U2 - 10.1186/s12877-020-01757-8
DO - 10.1186/s12877-020-01757-8
M3 - Article
C2 - 32993531
AN - SCOPUS:85092334887
VL - 20
JO - BMC Geriatrics
JF - BMC Geriatrics
SN - 1471-2318
IS - 1
M1 - 371
ER -