Frailty in Nondialysis CKD May Up Risk for Cardiovascular Events, Mortality – Renal and Urology News

Both pre-frail and frail patients with nondialysis-dependent chronic kidney disease (CKD) have increased risks for cardiovascular events and death, a new study finds.

Among 2539 adults in the Chronic Renal Insufficiency Cohort (CRIC) Study, 12% were frail, 51% were pre-frail, and 37% were non-frail. At baseline, patients received 1 point for each frail criterion they met, including slow gait, exhaustion, muscle weakness, weight loss, and low physical activity. Non-frail was defined as a score of 0, pre-frail as a score of 1-2, and frail as a score of 3-5. Estimated glomerular filtration rate (eGFR), per protocol, ranged from 20 to 70 mL/min/1.73m² based on a race-free creatinine-cystatin formula.

The risk for atherosclerotic events (including myocardial infarction, peripheral artery disease, and stroke) was a significant 1.8- and 2.0-fold higher for pre-frail and frail patients, respectively, compared with the non-frail group, Mary Hannan, PhD, NP, of University of Illinois Chicago and colleagues reported in the American Journal of Kidney Diseases. The risk for new-onset heart failure was a significant 1.4- and 2.2-fold higher for pre-frail and frail patients, respectively.

The risk for cardiovascular death significantly increased 1.8- and 3.0-fold for the pre-frail and frail groups, respectively, whereas the risk for noncardiovascular death significantly increased 1.8- and 2.5-fold, respectively, the investigators reported. The risk for all-cause mortality was a significant 1.8- and 2.5-fold higher for the pre-frail and frail groups, respectively.

Frail adults were more likely to be older, female, and unmarried and to have lower eGFR, more proteinuria, and higher rates of diabetes, hypertension, and/or cardiovascular disease. Yet their baseline medical condition did not fully account for their excess risks.

“Although frail individuals in our cohort had a higher prevalence of cardiovascular risk factors at baseline, the associations between frailty and risk for an atherosclerotic event, incident heart failure, and cardiovascular death remained robust even after adjustment for risk factors,” Dr Hannan’s team pointed out. The investigations suggested that frailty screening may be a useful addition for risk stratification and possible interventions.

Of the cohort, 47% were White, 38% Black, 11% Hispanic, and 4% other ethnicities.

Reference

Hannan M, Chen J, Hsu J, et al; CRIC Study Investigators. Frailty and cardiovascular outcomes in adults with CKD: Findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis. Published online September 17, 2023. doi:10.1053/j.ajkd.2023.06.009