Abstract: TH-PO782

The Influence of Frailty and Body Composition on Risk of Mortality in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Fitzpatrick, Jessica, University of Toronto, Toronto, Ontario, Canada
  • Sozio, Stephen M., Johns Hopkins University , Baltimore, Maryland, United States
  • Jaar, Bernard G., Johns Hopkins University , Baltimore, Maryland, United States
  • Estrella, Michelle M., UCSF/San Francisco VA Medical Center, San Francisco, California, United States
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins University , Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University , Baltimore, Maryland, United States
  • Parekh, Rulan S., University of Toronto, Toronto, Ontario, Canada
  • McAdams-DeMarco, Mara, Johns Hopkins University , Baltimore, Maryland, United States
Background

Increased body mass index (BMI) is associated with lower risk of mortality in end stage renal disease (ESRD). Frailty is a phenotype of decreased physiologic reserve common among hemodialysis (HD) patients and associated with sarcopenia in this population. We sought to understand the role of body composition on mortality among frail and non-frail incident HD patients.

Methods

This study included 370 incident HD patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD (PACE) Study. Frailty was defined as presence of ≥ 3 of the following: shrinkage, weakness, reduced gait speed, exhaustion, and low physical activity. General and abdominal adiposity were assessed with BMI and waist-to-hip ratio (WHR), respectively. Proportional hazards regression was used to estimate the association of frailty and WHR with all-cause mortality.

Results

The mean age was 55 years, 42% were female, 73% were African American, 57% had diabetes, the mean comorbidity index was 5.2, and 52% were frail. BMI, but not WHR, was higher (P<0.05) among frail vs. non-frail participants. There were 81 deaths over a mean of 2.5 years of follow-up. Frailty, but not WHR, was associated with higher mortality risk. There was no evidence of an interaction between frailty and BMI (P=0.33) or WHR (P=0.88). There was, however, a trend for stronger association between frailty and mortality among those above the median WHR.[Figure]

Conclusion

Frailty was associated with higher risk of mortality independently of WHR and BMI. These results suggest that general and central adiposity do not mitigate the influence of frailty on mortality among HD patients.

Funding

  • NIDDK Support