FRAILTY, PHYSICAL PERFORMANCE AND FALLING RISK IN OLDER ADULTS WITH PRE-DIALYSIS CHRONIC KIDNEY DISEASE

T.-H. Chen^1,2, Y.-C. Tsai^2,3,4,5,6, S.-F. Hsiao^1,7,8,9

¹Kaohsiung Medical University, Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung, Taiwan, ²Kaohsiung Medical University Hospital, Division of Nephrology, Kaohsiung, Taiwan, ³Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung, Taiwan, ⁴Kaohsiung Medical University Hospital, Division of General Medicine, Kaohsiung, Taiwan, ⁵Kaohsiung Medical University, Drug Development and Value Creation Research Center, Kaohsiung, Taiwan, ⁶Kaohsiung Medical University, Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan, ⁷Kaohsiung Medical University, Department of Physical Therapy, College of Health Sciences, Kaohsiung, Taiwan, ⁸Kaohsiung Medical University Hospital, Division of Physical Therapy, Department of Rehabilitation Medicine, Kaohsiung, Taiwan, ⁹Kaohsiung Medical University Hospital, Department of Medical Research, Kaohsiung, Taiwan

Background: Chronic kidney disease (CKD) is one of the global leading problems linked with severe health consequence such as renal dialysis, renal replacement therapy and even leading to death. Identifying the status of frailty and physical performance of the older pre-dialysis CKD patients may improve the long-term care planning and prevent further dependency as the CKD progressed.

Purpose: This study explored the prevalence of frailty, status of physical performance and the risk of fall among three age groups of the elderly CKD outpatients.

Methods: With ethical approval, pre-dialysis CKD patients aged between 65-95 years were recruited from an outpatient nephrology department of a medical centre. They were examined on the status of frailty and the related physiological and physical performance. The risk factors associated with frailty were also investigated in this particular population. The key muscle strength from upper and lower limbs, handgrip strength, time to complete the Five Times Sit-to-Stand Test (FTSST) and 3m Timed Up-and-Go Test (TUGT) were also measured and quantified with standardized methods. The participants were also interviewed for the activities of daily life with Barthel Index (BI), screened for sarcopenia (using SARC-F), and using Clinical Frailty Scale (CFS) to categorize them into frail and non-frail groups.

Results: There were 191 CKD outpatients (76.41±6.47 years, 99 females) recruited and109 of them were classified as frail (CFS≥4), with significantly higher age and later CKD staging (stage 3b-5). The frail group had significantly higher scores and higher ratio of people at risk for sarcopenia (p<0.001). Physical assessment also showed that the handgrip (21.16±6.66kg vs 27.65±8.07kg), biceps (24.80±10.99kg vs 33.83±13.09kg) and quadriceps (35.26±13.25kg vs 47.32±18.27kg) strength were significantly lower (p=0.001-0.031), and the FTSST (17.85±6.67s vs 12.60±4.20s) and TUGT (16.12±6.01s vs11.13±2.68s) time significantly longer (p<0.001). When using the time of TUGT to determine the risk of falls, this study found that both males and females in the frail group were classified as high risk (p<0.001).

Conclusions: This study identified 57.07% of the pre-dialysis CKD older patients were frail. The frail group was older, with poorer renal function, had a higher risk of sarcopenia and poorer physical performance. There was also a higher risk of falls in the frail group among these patients.

Implications: Pre-dialysis CKD patients with frailty were found to be weaker and more likely to fall. It is suggested that frailty assessment can be incorporated into regular clinical routines and clinical care indicators for CKD patients from early stage to prevent deterioration and disability, and to improve the quality of life of the CKD elderly.

Funding acknowledgements: There is no funding support for this research.

Keywords:
Older persons
Chronic Kidney Disease (CKD)
Frailty

Topics:
Non-communicable diseases (NCDs) & risk factors
Health promotion & wellbeing/healthy ageing/physical activity
Older people

Did this work require ethics approval? Yes

Institution: Kaohsiung Medical University Chung-Ho Memorial Hospital

Committee: Institutional Review Board

Ethics number: KMUHIRB-E(II)-20200168