Frailty may double risk of in-hospital mortality for patients on dialysis
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United States patients who received maintenance dialysis for ESRD and also had frailty experienced significantly worse in-hospital outcomes than patients on dialysis without frailty, according to study results.
“ESRD constitutes a unique group of patients who are frequently hospitalized, with an in-hospital mortality averaging [six- to eight]-times greater than that of the general population,” Xinxin Jiang, MD, of the department of nephrology at Zhejiang Hospital in China, and colleagues wrote. “Frailty in patients with ESRD further exacerbates these poor outcomes, significantly increasing the risks of hospitalization and death.”
As prevalence of both conditions is growing, the researchers argued that “understanding the effects of frailty on in-hospital outcomes is essential to address the specific needs of a large number of patients.”
They identified 1,424,026 patients on maintenance dialysis who were hospitalized between 2005 and 2014, and classified patients according to frailty status. Adjustments were made for age, sex, race, income, insurance status, Charlson comorbidity index and hospital location.
Researchers determined patients with frailty had a 2.4-times increased risk of in-hospital mortality compared with those without frailty. In addition, frailty was associated with a 3.55-times greater risk of discharge to long-term facilities, as well as longer hospital stays (approximately 5 more days) and increased hospital costs (approximately $40,000 more).
“A review of interventions for frailty concludes that numerous methods have been shown to be feasible, safe, and effective in reducing the level of frailty in older community-dwelling frail individuals, including individualized exercise programs, psychological and social support, and an emphasis on adequate nutritional intake,” the researchers wrote.
However, because the impact of frailty on each outcome was more pronounced in patients younger than 65 years, the researchers argued that frailty should be carefully assessed and monitored in all patients with ESRD, regardless of age, and interventions should be tested in the entire population. – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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