Frailty, but not cognitive impairment, improves mortality risk prediction among those with chronic kidney disease-a nationally representative study.
| Autor: | Hong J; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA., Chu NM; Department of Surgery, Johns Hopkins University, Baltimore, MD, USA., Cockey SG; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA., Long J; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA., Cronin N; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA., Ghildayal N; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA., Hall RK; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.; Durham Veterans Affairs Medical Center, Durham, NC, USA., Huisingh-Scheetz M; Department of Medicine, University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL, USA., Scherer J; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., Segev DL; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., McAdams-DeMarco MA; Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA. Mara.McAdamsDeMarco@nyulangone.org.; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA. Mara.McAdamsDeMarco@nyulangone.org. |
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| Jazyk: | angličtina |
| Zdroj: | BMC nephrology [BMC Nephrol] 2024 May 22; Vol. 25 (1), pp. 177. Date of Electronic Publication: 2024 May 22. |
| DOI: | 10.1186/s12882-024-03613-y |
| Abstrakt: | Background: Though older adults with chronic kidney disease (CKD) have a greater mortality risk than those without CKD, traditional risk factors poorly predict mortality in this population. Therefore, we tested our hypothesis that two common geriatric risk factors, frailty and cognitive impairment, and their co-occurrence, might improve mortality risk prediction in CKD. Methods: Among participants aged ≥ 60 years from National Health and Nutrition Examination Survey (2011-2014), we quantified associations between frailty (physical frailty phenotype) and global/domain-specific cognitive function (immediate-recall [CERAD-WL], delayed-recall [CERAD-DL], verbal fluency [AF], executive function/processing speed [DSST], and global [standardized-average of 4 domain-specific tests]) using linear regression, and tested whether associations differed by CKD using a Wald test. We then tested whether frailty, global cognitive impairment (1.5SD below the mean), or their combination improved prediction of mortality (Cox models, c-statistics) compared to base models (likelihood-ratios) among those with and without CKD. Results: Among 3,211 participants, 1.4% were cognitively impaired, and 10.0% were frail; frailty and cognitive impairment co-occurrence was greater among those with CKD versus those without (1.2%vs.0.1%). Frailty was associated with worse global cognitive function (Cohen's d = -0.26SD,95%CI -0.36,-0.17), and worse cognitive function across all domains; these associations did not differ by CKD (p Conclusions: Frailty is associated with worse cognitive function regardless of CKD status. While CKD and frailty improved mortality prediction, cognitive impairment did not. Risk prediction tools should incorporate frailty to improve mortality prediction among those with CKD. (© 2024. The Author(s).) |
| Databáze: | MEDLINE |
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