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Kidney Week

Abstract: PO1388

Association of CKD Stages with Frailty Worsening or Death in Community-Dwelling Older Adults

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Mielke, Nina, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Schneider, Alice, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Ebert, Natalie, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • van der Giet, Markus, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Huscher, Doerte, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Kuhlmann, Martin K., Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany
  • Schaeffner, Elke, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
Background

Albumin-creatinine-ratio (ACR) and glomerular filtration rate (GFR) have been associated with prevalent and incident frailty. We analyzed the association of the KDIGO CKD stages and frailty status worsening or death in data of the Berlin Initiative Study (BIS).

Methods

Prospective population-based cohort study interviewing participants biannually with a standardized questionnaire. Frailty assessment according to Fried took place at the 3rd and 4th follow-up. Frailty worsening was defined as the transition within a two-year period from robust to prefrail or frail, or from prefrail to frail. Partial proportional odds regression analysis was used to analyze the association between KDIGO CKD stages and the ordinal outcome of no worsening, frailty worsening, or death.

Results

Of 1076 participants with 46% male and mean age 84.3 years, initially 48% were prefrail and 32% frail. After 2.1 (2.0-2.3) years of follow-up 188 (17.5%) had worsened and 111 (10.3%) died. Participants who died were older (88 vs. 83 yrs), were less physically active, had less muscle mass (calve circumference <31: 10% vs. 5%), and were more likely to be cognitively impaired; 92% had a GFR <60 mL/min/1.73m2 and 59% had an ACR ≥30 mg/g compared to 72% and 24% in participants who did not worsen, respectively. Baseline characteristics of participants who worsened were similar to participants who did not worsen.
In the multivariable1 model participants in CKD stages G1,2/A2,3 and G3/A1 or higher had about 2-fold higher odds of frailty worsening than in CKD stages G1,2/A1. The odds for death increased remarkably with both higher CKD stage and increasing albuminuria. Wide confidence intervals are likely due to limited sample size/events. Additional adjustment for frailty baseline status did not alter the results.

Conclusion

In older adults, advanced CKD stages but also albuminuria independent of GFR were associated with 2-fold higher odds of frailty worsening independent of death.

Funding

  • Private Foundation Support