Kidney Week

Abstract: TH-PO796

Association of ACR Trajectories With Frailty Worsening or Death in Community-Dwelling Older Adults

Session Information

• Voices, Choices, and Outcomes of Older Adults with CKD
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1200 Geriatric Nephrology

Authors

• Mielke, Nina, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Nina Mielke,

• Schneider, Alice, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Alice Schneider,

• Ebert, Natalie, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Natalie Ebert,

• van der Giet, Markus, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Markus van der Giet,

• Huscher, Doerte, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Doerte Huscher,

• Kuhlmann, Martin K., Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany

Martin K. Kuhlmann,

• Schaeffner, Elke, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany

Elke Schaeffner,

Background

Elevated Albumin-creatinine-ratio (ACR) has been associated with prevalent and incident frailty. We analyzed the association of ACR trajectories over 6 years and frailty status worsening or death in the successive 2-year follow up window in data of the Berlin Initiative Study (BIS).

Methods

Prospective population-based cohort of old adults interviewed biennially with a standardized questionnaire incl. geriatric and physical examination. 6-year ACR trajectories were constructed using either “no albuminuria (A0)” or “albuminuria (A1) (30 – 300 mg/g)” or “A2 (>300 mg/g)” over four study visits. Trajectories were distinguished into “stable A0” or “all other” trajectories of albuminuria incl. incident albuminuria. Frailty was assessed at the 3^rd (frailty baseline) and 4^th follow-up. Frailty worsening was defined as the transition from robust to prefrail or frail, or from prefrail to frail within the 2-year period. Association between ACR trajectories and the ordinal outcome of no worsening, frailty worsening, or death was analyzed using partial proportional odds regression.

Results

At frailty baseline, mean age was 84 yrs, 46% were male, and 48% were prefrail and 31% frail. Participants with trajectories of albuminuria during the previous 6 years (N=342) were older (86 vs. 84 yrs), were less physically active, had higher prevalence of diabetes (39% vs. 24%) or CVD (83% vs. 66%) and had a lower mean eGFR of 45 compared to 53 mL/min/1.73 m² in participants with stable A0 trajectories (N=729).
After 2.1 (2.0-2.3) years, 960 (90%) participants had valid information on frailty transition: 187 (17.5%) worsened and 111 (10.3%) died. In the multivariable model¹ the odds of frailty worsening for participants with albuminuria trajectories during the 6 yrs preceding initial frailty assessment were 1.5-fold higher compared to participants with stable A0 trajectories. The odds for death were even higher with albuminuria trajectories.

Conclusion

In older adults, albuminuria trajectories are associated with 1.5-fold higher odds for frailty worsening independent of death.

Funding

• Private Foundation Support