Clinical research studyFrailty and Chronic Kidney Disease: The Third National Health and Nutrition Evaluation Survey
Section snippets
Data Source
We obtained individual-level data from NHANES III, a nationally representative survey of the health status of persons residing in the United States collected between 1988 and 1994. NHANES III is a cross-sectional, multistage, stratified, clustered probability sample of the US civilian noninstitutionalized population conducted by the National Center for Health Statistics, a branch of the Centers for Disease Control and Prevention.14 The first of multiple planned mortality linkages was conducted
Results
Of the 33,994 NHANES III participants, 10,256 participants, representative of approximately 100 million Americans, met inclusion criteria (Table 1). The overall rate of frailty was 2.8% (standard error, 0.34). The prevalence of frailty was significantly higher among participants with chronic kidney disease, particularly evident with eGFR less than 45 mL/min/1.73 m2 (Table 2). Rates of positive response in individual frailty domains ranged from 2.6% to 21.9%. The odds of frailty were
Discussion
We estimated that approximately 3% of US adults and approximately 5% of those aged more than 60 years were frail. Frailty was significantly more common in persons with chronic kidney disease. Even among persons with mild or early-stage chronic kidney disease, frailty was approximately twice as likely compared with those without chronic kidney disease. Persons with more severe chronic kidney disease were more likely to be frail. Frailty also was more common in persons with moderate to severe
Conclusions
We confirmed the strong association between frailty and chronic kidney disease in the general US population. The association was especially strong among persons with an eGFR less than 45 mL/min/1.73 m2, but was substantial even among those with microalbuminuria and normal eGFR. Frailty and chronic kidney disease were independently associated with mortality. Given the prevalence of chronic kidney disease, especially among the elderly, and increasing evidence linking frailty to early mortality,
References (23)
- et al.
Frailty
Med Clin North Am
(2006) Vulnerability in the elderly: frailty
Med Clin North Am
(2006)Diabetes, sarcopenia, and frailty
Clin Geriatr Med
(2008)- et al.
Functional decline among older adults: comparing a chronic disease cohort and controls when mortality rates are markedly different
J Clin Epidemiol
(2000) - et al.
Physical and sexual function in women with chronic kidney disease
Am J Kidney Dis
(2004) - et al.
Chronic kidney disease and cognitive impairment in menopausal women
Am J Kidney Dis
(2005) - et al.
The presence of frailty in elderly persons with chronic renal insufficiency
Am J Kidney Dis
(2004) - et al.
Measured and estimated GFR in healthy potential kidney donors
Am J Kidney Dis
(2004) - et al.
Operationalizing a frailty index from a standardized comprehensive geriatric assessment
J Am Geriatr Soc
(2004) - et al.
Frailty in older adults: evidence for a phenotype
J Gerontol A Biol Sci Med Sci
(2001)
A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline
J Clin Nurs
Cited by (0)
Funding: This research was funded by a grant from the Stanford University School of Medicine Medical Scholars Program.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.