Kidney Week

Abstract: PUB128

Frailty, Hospitalization, and Mortality in an Irish Haemodialysis Cohort

Session Information

• Publication Only

Category: Geriatric Nephrology

• 1300 Geriatric Nephrology

Authors

• Shahzad, Varisha, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Varisha Shahzad, MBBS, MPH

• Collins, Lucy Elizabeth, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Lucy Elizabeth Collins

• Redahan, Lynn, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Lynn Redahan, MBChB

• O'Meara, Yvonne M., Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Yvonne M. O'Meara, MD, MBChB

• Sadlier, Denise M., Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Denise M. Sadlier, MD, PhD

• Doyle, Ross, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Ross Doyle, MBChB, PhD

• Cormican, Sarah, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

Sarah Cormican, MBChB

Background

Frailty is a key determinant of outcomes in maintenance haemodialysis. As per the "World Population Aging 2019" report by 2050, 1 in 6 members of the world's population will be at least 65 years of age, compared to fewer than 1 in 10 today. Frailty has many implications, especially in the dialysis cohort, not only is it associated with an increased risk of falls and hospitalization, it also puts the dialysis patients at an increased risk of mortality when compared to the non-frail dialysis patients.

To the best of our knowledge this is the first Irish study to determine the frailty score in haemodialysis patients using the Clinical Frailty Scale (CFS) and its association with the number of hospitalizations, the average length of stay, the number of hospitalizations related to falls and mortality in a tertiary centre.

Methods

This is a retrospective study of 37 patients receiving maintenance haemodialysis at a tertiary centre. Frailty was measured using the CFS. Outcomes included hospital admissions, mean length of stay, fall-related admissions and mortality. Associations were analysed using non-parametric tests and multivariable regression adjusted for age and sex.

Results

Forty-one percent were frail (CFS 6-9). Greater frailty was associated with higher admission rates (r=0.38, p=0.021) and longer stays (r=0.49, p=0.002). Each point increase in CFS predicted a 36% higher admission rate (IRR 1.36, p=0.034) and 62% longer stays (beta=0.48, p=0.026). In contrast, frailty was not associated with fall-related hospitalizations (OR=1.33, 95% CI 0.67-2.62, p=0.42). Mortality increased sharply with frailty (OR 25.3, p=0.007).

Conclusion

This study demonstrated a statistically significant positive association between frailty and the number of hospital admissions since starting dialysis and a stronger statistically significant association with average length of stay, however, it did not show that frailty had a statistically significant impact on fall-related hospitalizations. In addition, frailty was a powerful independent predictor of mortality, with death rates rising sharply across frailty levels.

While it may be expected that frail patients experience worse outcomes, this study provides important real-world evidence within an Irish haemodialysis population, where such data is currently limited. Quantifying the magnitude of these associations is essential for informing clinical practice and resource allocation.