Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis
Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis
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DOI：
10.1159/000439000
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发表时间：
2015-01-01
影响因子：
4.2
通讯作者：
Johansen, Kirsten L.
中科院分区：
文献类型：
--
作者：
Delgado, Cynthia;Shieh, Stephanie;Johansen, Kirsten L.
背景：尽管在一般人群中，虚弱与较高的跌倒和骨折风险有关，但只有少数研究调查了终末期肾病患者（这些事件的风险特别高）虚弱与这些结果的关联程度。方法：2005年9月至2007年6月，在美国297个透析单位开始维持性血液透析的1,646例患者被纳入综合透析研究，1,053名医疗保险受益人被纳入该研究。自我报告的虚弱被定义为患者支持以下2项或更多：身体功能差，疲惫或体力活动少。需要医疗护理的跌倒和骨折是通过医疗保险索赔数据确定的。我们使用Cox比例风险回归的Fine-Gray修正法，对人口统计学、Quetelet体重指数、糖尿病、心力衰竭和动脉粥样硬化进行了调整，检验了虚弱与首次跌倒或骨折时间之间的关系。结果：77%的患者自述身体虚弱。中位随访时间为2.5（1.0-3.9）年。在非虚弱和自我报告虚弱的参与者中，首次医疗紧急跌倒或骨折的粗略比率分别为66和126 / 1000人年。在考虑了人口统计学因素、合并症和死亡的竞争风险后，自我报告的虚弱与需要就医的跌倒或骨折的高风险相关（风险比1.60,95% CI 1.16-2.20）。结论：报告虚弱的参与者经历了医学紧急跌倒或骨折的风险几乎是没有报告虚弱的参与者的两倍。(C) 2015 S. Karger AG，巴塞尔
Background: Although frailty has been linked to higher risk of falls and fracture in the general population, only few studies have examined the extent to which frailty is associated with these outcomes among patients with end-stage renal disease, who are at particularly high risk for these events. Methods: A total of 1,646 patients who were beginning maintenance hemodialysis in 297 dialysis units throughout the United States from September 2005 to June 2007 were enrolled in the Comprehensive Dialysis Study, and 1,053 Medicare beneficiaries were included in this study. Self-reported frailty was defined by the patients endorsing 2 or more of the following: poor physical functioning, exhaustion or low physical activity. Falls and fractures requiring medical attention were identified through Medicare claims data. We examined the association between frailty and the time to first fall or fracture using the Fine-Gray modification of Cox proportional hazards regression, adjusted for demographics, Quetelet's body mass index, diabetes mellitus, heart failure and atherosclerosis. Results: Seventy-seven percent of patients were frail by self-report. The median length of follow-up was 2.5 (1.0-3.9) years. Crude rates of first medically urgent falls or fractures were 66 and 126 per 1,000 personyears in non-frail and self-reported frail participants, respectively. After accounting for demographic factors, comorbidities and the competing risk of death, self-reported frailty was associated with a higher risk of falls or fractures requiring medical attention (hazards ratio 1.60, 95% CI 1.16-2.20). Conclusion: Participants reporting frailty experienced nearly twice the risk of medically urgent falls or fractures compared to those who did not report frailty. (C) 2015 S. Karger AG, Basel