Risk factors for frailty in a large prevalent cohort of hemodialysis patients.

BACKGROUND: Although individuals with kidney disease, including those dependent on dialysis, often present clinically with signs and symptoms consistent with frailty, there is limited information about sociodemographic and clinical risk factors that may be associated.

METHODS: Seven hundred forty-five patients undergoing hemodialysisbetween 2009 and 2011 in 7 Atlanta dialysis clinics and 7 San Francisco bay area dialysis clinics were assessed using the validated Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity) that defines frailty as the presence of 3 or more criteria. Study coordinators interviewed participants; measured grip strength, walk speed, and body composition; and reviewed records for clinical and laboratory parameters. Logistic regression models were used to estimate the association of patient characteristics with frailty.

RESULTS: In adjusted analyses, peripheral vascular disease and cardiac diseases, including dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest, were associated with higher odds for frailty, whereas black race and higher serum albumin concentration were associated with lower odds for frailty.

CONCLUSIONS: In multivariable analyses, the risk for frailty in patients undergoing hemodialysis, as assessed by the presence of 3 or more criteria that comprise the Fried frailty index, was increased in association with peripheral vascular disease and cardiac conditions, such as dysrhythmia and atrial fibrillation, and was decreased for those with higher serum albumin concentration and for blacks compared with whites. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures.