Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study.

OBJECTIVES: Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients. DESIGN: In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given. PARTICIPANTS: Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients. MEASUREMENTS: Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group. RESULTS: The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both). CONCLUSION: Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

The role of fetuin-A in cardiac functions and metabolism in peritoneal dialysis patients.

AIM: Fetuin-A is a member of protease inhibitors that act as an inhibitor of vascular calcification. In our study, the relationship of fetuin-A with metabolic and echocardiographic parameters in peritoneal dialysis (PD) patients has been investigated. METHODS: Besides demographic, clinical and laboratory data, fetuin-A level was recorded. Echocardiographic examinations were performed by the same operator. RESULTS: Fifty-two chronic PD patients (mean age: 52.7 ± 15.4 years) and 31 healthy volunteers (mean age: 41.3 ± 10.7 years) were included. Fetuin-A levels were significantly lower in the patient group (57.5 ± 31.5 ng/mL vs. 72.5 ± 34.0 ng/mL, P = 0.002). There was a significant relation between age and fetuin-A levels (P = 0.025). Four patients with chronic heart failure had significantly lower fetuin-A levels compared with those without. There was no relation between fetuin-A levels and the presence of diabetes mellitus, left ventricular hypertrophy and ischemic heart disease. No relationship was detected between fetuin-A level and any echocardiographic parameter. Age and hematocrite were correlated negatively, and serum albumin positively with fetuin-A levels. On linear regression analysis, fetuin-A level was related with age, hematocrite and presence of heart failure. CONCLUSION: PD patients with heart failure have significantly lower fetuin-A levels. Age is a main determinant of fetuin-A level and fetuin-A may act as a negative acute phase reactant in PD patients.