TY - JOUR
T1 - The impact of frailty on technique failure and mortality in patients on home dialysis
AU - Brar, Ranveer
AU - Whitlock, Reid
AU - Komenda, Paul
AU - Lerner, Blake
AU - Prasad, Bhanu
AU - Bohm, Clara
AU - Thorsteinsdottir, Bjoerg
AU - Rigatto, Claudio
AU - Tangri, Navdeep
N1 - Funding Information:
PK is the chief medical officer at Quanta Dialysis Technologies Ltd. BT’s institution received funding from the National Institute on Aging K23 AG051679 award. NT has received honoraria from Otsuka Pharmaceutical Inc., Tricida Inc., and AstraZeneca Inc. and has received research support from AstraZeneca Inc. All other authors declare that they have no conflict of interest or relevant financial interests.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background: Patients on home dialysis therapies experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. We investigated the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies. ♥Methods: We collected objective (Fried criteria and Short Physical Performance Battery [SPPB]), and subjective (physician and nurse impression) measures of frailty from 109 prevalent home dialysis patients. Our primary outcome was a composite of technique failure, defined as a permanent unplanned transition (> 30 days in duration) to facility-based hemodialysis or all-cause death. The association between different frailty assessment tools and the primary composite outcome was evaluated using Cox models. ♥Results: Fried criteria and physician impression was associated with a greater than 2-fold increase in risk of our composite outcome (HR: 2.10 [95% CI 1.09 - 3.99], 2.15 [95% CI 1.15 - 4.00, respectively] in adjusted analyses. Weakness and weight loss subdomains of the Fried criteria were both associated with an increased risk of our composite outcome in adjusted analyses (HR: 2.16 [95% CI 1.23 - 3.78], 2.69 [95% CI 1.39 - 5.40], respectively). ♥Conclusions: Objective and subjective measures of frailty are associated with a more than 2-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management.
AB - Background: Patients on home dialysis therapies experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. We investigated the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies. ♥Methods: We collected objective (Fried criteria and Short Physical Performance Battery [SPPB]), and subjective (physician and nurse impression) measures of frailty from 109 prevalent home dialysis patients. Our primary outcome was a composite of technique failure, defined as a permanent unplanned transition (> 30 days in duration) to facility-based hemodialysis or all-cause death. The association between different frailty assessment tools and the primary composite outcome was evaluated using Cox models. ♥Results: Fried criteria and physician impression was associated with a greater than 2-fold increase in risk of our composite outcome (HR: 2.10 [95% CI 1.09 - 3.99], 2.15 [95% CI 1.15 - 4.00, respectively] in adjusted analyses. Weakness and weight loss subdomains of the Fried criteria were both associated with an increased risk of our composite outcome in adjusted analyses (HR: 2.16 [95% CI 1.23 - 3.78], 2.69 [95% CI 1.39 - 5.40], respectively). ♥Conclusions: Objective and subjective measures of frailty are associated with a more than 2-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management.
KW - CKD
KW - Chronic kidney disease
KW - HHD
KW - Home hemodialysis
KW - PD
KW - Peritoneal dialysis
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U2 - 10.3747/pdi.2018.00195
DO - 10.3747/pdi.2018.00195
M3 - Article
C2 - 31582467
AN - SCOPUS:85074619817
VL - 39
SP - 532
EP - 538
JO - Peritoneal Dialysis International
JF - Peritoneal Dialysis International
SN - 0896-8608
IS - 6
ER -