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Kidney Week

Abstract: FR-PO438

Frailty in Patients on Dialysis Surviving for More than 40 Years Is Common and Severe: A Nationwide Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yamamoto, Suguru, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
  • Niihata, Kakuya, Fukushima Medical University, Fukushima, Japan
  • Toida, Tatsunori, Kyushu University of Health and Welfare, Miyazaki, Japan
  • Abe, Masanori, Nihon University School of Medicine, Tokyo, Japan
  • Hanafusa, Norio, Tokyo Women's Medical University, Tokyo, Japan
  • Kurita, Noriaki, Fukushima Medical University, Fukushima, Japan
Background

The number of end-stage kidney disease (ESKD) patients with a more prolonged dialysis vintage have been increasing. Recently, the Japan Society for Dialysis Therapy (JSDT) survey reporting patients on dialysis for over 40 years has been presented, and there are few reports that describe their characteristics, especially regarding physical function. This study aimed to evaluate the clinical features of ESKD patients on dialysis for 40 years or more and the associations between dialysis vintage and frailty using the JSDT Renal Data Registry database.

Methods

A cross-sectional study was conducted. The analysis included data of 227,136 patients aged over 50 on dialysis in 2018. The dialysis vintage exposure was categorized as: 0–<5 years; 5–<10 years;10–<20 years; 20–< 30 years; 30–<40 years; and above 40 (40–) years. The primary outcome was frailty, defined as grade 2 or higher according to the Eastern Cooperative Oncology Group Performance Status (ECOG PS) scale. The secondary outcome was bedridden, defined as grade 4 on the ECOG PS scale. Modified Poisson regression models adjusted for potential covariates were used to estimate the adjusted prevalence ratios (aPRs) for frailty and bedridden. The clinical characteristics of patients with dialysis vintage of 40 years or more were compared with those in other dialysis vintage categories.

Results

Total 809 (0.36%) ESKD patients were on dialysis for 40 years or more. This group showed a lower proportion of men and presence of diabetes. Histories of fractures and carpal tunnel syndrome were more frequent in the 40– years than in the other groups. The prevalence of frailty was most common in the 40– years group (54.6%), and the prevalence of bedridden was similar (9.9%). The dialysis vintage 40- years vs. 0-<5 years was associated with increased frailty (aPR [95% confidence interval]: 2.41 [2.25-2.58]), and bedridden (aPR [95% confidence interval]: 2.12 [1.72-2.60]).

Conclusion

This large nationwide study found an association between dialysis vintage and frailty in dialysis patients. Long-term dialysis therapy, particularly for over 40 years, may accelerate the decline of physical function, probably due to unmeasured dialysis-related factors.