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Abstract: TH-PO988

Estimated Glomerular Filtration Rate Predicts Frailty After 3 Months in Patients Admitted to Emergency Department

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Meyer, Anna Maria, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany
  • Benzing, Thomas, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany
  • Burst, Volker Rolf, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany
  • Polidori, M. Cristina, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany
  • Mueller, Roman-Ulrich, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany
Background

Renal failure and frailty are interwoven and common conditions in patients seeking help in emergency departments (ED). Despite the impact on patients’ trajectories, their association and severity degree are not systematically evaluated.

Methods

Data from 937 multimorbid patients (76.3 ±7.0 years, 43% women) randomized to either geriatric co-management (GM) or usual care, to investigate the effects of GM on rehospitalization, were analyzed. Patients underwent routine care and comprehensive geriatric assessment (CGA) with calculation of the Multidimensional Prognostic Index (MPI). Kaplan-Meyer was used to calculate mortality outcomes, survival curves evaluated with Log-Rank test.

Results

5% of patients were frail, 43% pre-frail, 52% robust, 30-day mortality was 7.5%, 12.9% after 90 days. MPI-frailty was significantly associated with eGFR on admission (p<0.001), 73.2% of patients with an eGFR <15 ml/min/1.73m2 were classified as pre-frail or frail. Of patients with an eGFR of <30 ml/min/1.73m2, frail patients had a significantly higher mortality rate after 90-days compared to patients being classified as pre-frail/ robust (40.0% vs 16.8%/ 16.7%, p=0.045). Adjusted for age and sex, the eGFR was significantly associated with in-hospital mortality (p=0.041), but not significance after adjusting for MPI. Frailty was significantly associated with in-hospital mortality (p<0.001) independent of age, sex and eGFR. The eGFR on admission showed a significant association with the MPI-frailty after three months (adjusted for age, gender and MPI-group on admission, p<0.001, Fig.1).

Conclusion

In older multimorbid patients admitted to the ED, reduced eGFR is tightly associated to multidimensional frailty beyond the physical phenotype and is a strong, independent predictor for frailty at 3 months. The use of a frailty assessment combined with kidney function measures might enable ED physicians and nephrologists to recognize and treat factors beyond organ disease strongly associated with adverse outcomes.