Clinical research study
Frailty and Chronic Kidney Disease: The Third National Health and Nutrition Evaluation Survey

https://doi.org/10.1016/j.amjmed.2009.01.026Get rights and content

Abstract

Background

Frailty is common in the elderly and in persons with chronic diseases. Few studies have examined the association of frailty with chronic kidney disease.

Methods

We used data from the Third National Health and Nutrition Examination Survey to estimate the prevalence of frailty among persons with chronic kidney disease. We created a definition of frailty based on established validated criteria, modified to accommodate available data. We used logistic regression to determine whether and to what degree stages of chronic kidney disease were associated with frailty. We also examined factors that might mediate the association between frailty and chronic kidney disease.

Results

The overall prevalence of frailty was 2.8%. However, among persons with moderate to severe chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2), 20.9% were frail. The odds of frailty were significantly increased among all stages of chronic kidney disease, even after adjustment for the residual effects of age, sex, race, and prevalent chronic diseases. The odds of frailty associated with chronic kidney disease were only marginally attenuated with additional adjustment for sarcopenia, anemia, acidosis, inflammation, vitamin D deficiency, hypertension, and cardiovascular disease. Frailty and chronic kidney disease were independently associated with mortality.

Conclusion

Frailty is significantly associated with all stages of chronic kidney disease and particularly with moderate to severe chronic kidney disease. Potential mechanisms underlying the chronic kidney disease and frailty connection remain elusive.

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,

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    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.

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