TY - JOUR
T1 - Frailty, Kidney Function, and Polypharmacy
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Ballew, Shoshana H.
AU - Chen, Yan
AU - Daya, Natalie R.
AU - Godino, Job G.
AU - Windham, B. Gwen
AU - McAdams-DeMarco, Mara
AU - Coresh, Josef
AU - Selvin, Elizabeth
AU - Grams, Morgan E.
N1 - Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals. Study Design Observational study. Setting & Participants 4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013). Predictors Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio. Outcome Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity). Results 341 (7%) participants were classified as frail, 1,475 (30%) had eGFRcr < 60 mL/min/1.73 m2, 2,480 (50%) had eGFRcys < 60 mL/min/1.73 m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30 mg/g. Among frail participants, prevalences of eGFRcr and eGFRcys < 60 mL/min/1.73 m2 were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcr and a strong association with eGFRcys and albumin-creatinine ratio. Frail individuals with eGFRcr of 60 to <75 mL/min/1.73 m2 were frequently reclassified to lower eGFR categories using eGFRcys (49% to 45-<60, 32% to 30-<45, and 3% to <30 mL/min/1.73 m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants). Limitations Cross-sectional study design. Conclusions Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFRcys versus eGFRcr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.
AB - Background Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals. Study Design Observational study. Setting & Participants 4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013). Predictors Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio. Outcome Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity). Results 341 (7%) participants were classified as frail, 1,475 (30%) had eGFRcr < 60 mL/min/1.73 m2, 2,480 (50%) had eGFRcys < 60 mL/min/1.73 m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30 mg/g. Among frail participants, prevalences of eGFRcr and eGFRcys < 60 mL/min/1.73 m2 were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcr and a strong association with eGFRcys and albumin-creatinine ratio. Frail individuals with eGFRcr of 60 to <75 mL/min/1.73 m2 were frequently reclassified to lower eGFR categories using eGFRcys (49% to 45-<60, 32% to 30-<45, and 3% to <30 mL/min/1.73 m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants). Limitations Cross-sectional study design. Conclusions Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFRcys versus eGFRcr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.
KW - Frailty
KW - albuminuria
KW - biomarker
KW - chronic kidney disease (CKD)
KW - estimated glomerular filtration rate (eGFR)
KW - frail
KW - geriatric
KW - older adults
KW - polypharmacy
KW - prefrail
KW - reduced kidney function
KW - serum creatinine
KW - serum cystatin C
KW - urine albumin
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U2 - 10.1053/j.ajkd.2016.08.034
DO - 10.1053/j.ajkd.2016.08.034
M3 - Article
C2 - 27884475
AN - SCOPUS:85006967907
SN - 0272-6386
VL - 69
SP - 228
EP - 236
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -