The prevalence of frailty according to kidney function and its association with cognitive impairment, nutritional status, and clinical outcome

Abstract

Background Frailty is a state of vulnerability to poor homeostatic resolution of after a stressful event. The prevalence of frailty in patients with chronic kidney disease (CKD) is more common than in the general population. Frailty is associated with a poor clinical prognosis, malnutrition, and cognitive impairment; however, studies on these factors in patients with CKD are lacking. Therefore, we aimed to evaluate the relationship between CKD and frailty, nutritional status, and cognitive impairment and their influence on clinical outcomes. Methods We prospectively enrolled participants from June 2019 to December 2020 and divided them into three CKD groups according to kidney function (non-CKD, CKD stage 3–4, and CKD stage 5D). Clinical outcomes were defined as the composite outcomes of all-cause death, hospitalization, and cardiovascular outcomes, including nonfatal myocardial infarction, revascularization, or stroke. To calculate the relative risk of frailty, cognitive impairment, nutritional status, and clinical outcome, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis. Result A total of 88 patients were included, of whom 30.7% had frailty and 17.0% had cognitive impairment. In the CKD stage 5D group, the prevalence of frailty (56.7%, n = 17) was significantly higher, and the nutritional quotient score was lower in the other groups. The Korean-Montreal Cognitive Assessment score was significantly lower in the CKD stage 5D group; however, cognitive impairment did not differ among the three groups. Frailty was significantly associated with cognitive impairment and CKD stage 5D group. Cognitive impairment was significantly associated with older age and higher BMI. Well-nourished status was significantly associated with BMI and CKD stage 5D group. Patients in the CKD 5D group were significantly more likely to have adverse clinical outcomes. Conclusions The prevalence of frailty increased significantly as the CKD stage progressed. Particularly, CKD stage 5D group correlated with frailty and nutritional status, leading to poor clinical outcomes.