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Rapid eGFR decline associated with incident frailty in older adults
Researchers found fast eGFR decline — rather than baseline eGFR — was associated with incident frailty in older adults.
“Low kidney function, as assessed by estimated glomerular filtration rate (eGFR), is associated with morbidity and mortality in older adults, but also with poorer physical performance, loss of independence, and prevalent and incident frailty,” Florent Guerville, MD, of the Institute of Aging at Toulouse University Hospital in France, and colleagues wrote. “Nevertheless, a stable, moderately low eGFR (45 [mL/min per 1.73m2 to] 60 mL/min per 1.73m2) is common in older persons due to physiologic senescence of the kidneys, and is not systematically associated with poor outcome. By contrast, fast decline of eGFR, a hallmark of an active pathologic process, has been associated with mortality, cardiovascular morbidity and cognitive decline in older persons. However, to the best of our knowledge, the association between a fast decline of eGFR and incident frailty has never been assessed.”
Hypothesizing that fast decline of eGFR would be associated with incident frailty, researchers conducted a secondary analysis of 833 participants who were enrolled in the Multidomain Alzheimer Preventive Trial (median eGFR at baseline, 73 mL/min/1.73m2). eGFR was calculated at 6, 12 and 24 months with the lowest quartile of eGFR slope (more rapid than -4.1 mL/min/1.73 m2 per year) defined as a fast decline. Frailty was said to be present if a patient reported three or more of the following: unintentional weight loss, exhaustion, low physical activity, slow gait or low handgrip strength. No participants were frail at baseline or at 24 months, and follow-up lasted a mean of 53 months.
They found that, between 24 and 60 months, frailty occurred in 11% of participants. Of these, 15% had fast eGFR decline between baseline and 24 months (10% did not). Researchers observed that this decline was significantly associated with a higher hazard of incident frailty (HR = 1.67).
“Interestingly, we showed that fast eGFR loss was associated with frailty incidence, despite relatively preserved eGFR in our population,” they wrote. “Indeed, frailty has mostly been studied in patients with advanced CKD ... Our results suggest that people with more preserved kidney function, but exhibiting a hallmark of pathologic process such as fast eGFR decline, are also at risk for frailty incidence.”– by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.