Predictors and outcomes of frailty in dialysis patients

透析患者虚弱的预测因素和结果

• 批准号: 9055353
• 负责人: KIRSTEN L. JOHANSEN
• 金额: $ 63.23万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9055353
• 关键词: Address; Adverse event; Age; Biological Markers; Body Weight decreased; C-reactive protein; Caring; Cessation of life; Chronic Disease; Chronic Kidney Failure; Clinical; Cohort Studies; Communities; Comorbidity; Data; Data Collection; Development; Dialysis patients; Dialysis procedure; Elderly; End stage renal failure; Exercise; Fluid overload; Fracture; Functional disorder; Hemodialysis; High Prevalence; Hormones; Hospitalization; Impairment; Individual; Inflammation; Inflammatory; Information Systems; Interleukin-6; Intervention; Kidney; Lead; Maintenance; Obesity; Outcome; Patient Self-Report; Patients; Phenotype; Physical Function; Physical Performance; Physical activity; Physiological; Polypharmacy; Population; Prevalence; Prevention; Proxy; Quality of life; Recovery; Reporting; Resolution; Risk; Risk Factors; Sampling; Serum; Sleep; Stress; Sum; Syndrome; System; TNF gene; Testosterone; Tumor Necrosis Factor Receptor; United States; adipokines; adverse outcome; base; cohort; demographics; design; disability; exhaustion; falls; frailty; high risk; improved; indexing; inflammatory marker; information gathering; insight; meetings; modifiable risk; muscle metabolism; outcome prediction; premature; prevent; prognostic; prognostic value; public health relevance; remediation; sex; tool

 DESCRIPTION (provided by applicant): Although frailty is generally considered to be a geriatric syndrome, individuals with chronic diseases, including chronic kidney disease (CKD) are at risk for premature frailty. Many patients on hemodialysis are frail, including a sizeable proportion of those under age 65. Frailty is a syndrome resulting from cumulative declines in multiple physiologic systems, leading to impaired homeostatic reserve and decreased capacity to withstand stress. Operational definitions of frailty vary, but two general approaches have emerged: a deficit accumulation approach, in which an individual's impairments and conditions are summed to create a frailty index and a physical frailty phenotype characterized by a set of components that include weight loss, exhaustion, low physical activity, and poor physical performance or self-reported physical function or various proxies thereof. Frailty is associated with higher risk of adverse outcomes, such as hospitalization and death among community-dwelling elders and among patients receiving maintenance dialysis, in whom the prevalence of frailty is much higher than even the general elderly population. Studies exploring correlates of frailty in the dialysis population have focused on the frailty phenotype approach and have emphasized demographics and comorbidities rather than potentially modifiable risk factors or pathophysiology. Specifically, the potential contributions of inflammation, hormone abnormalities, fluid overload, myokines, and polypharmacy have been under-investigated despite their potential for remediation. In addition, frailty has generally been treated as a stati condition, with studies determining outcomes after a single baseline assessment of frailty. A better understanding of the development, and in some cases, resolution of frailty could lead to better insight into its prevention and treatment. Finally, there has been little comparison of the prognostic information afforded by different definitions of frailty or by the individual components of frailty constructs among patients with end-stage renal disease (ESRD). The objective of this application is to thoroughly characterize frailty among patients on hemodialysis - its origins and clinical correlates, its trajectory, and factors related to its development and resolution. The rationale for undertaking these analyses is to gather information that can be used to prevent or mitigate frailty and its sequelae. We propose to leverage the data collected in a USRDS special study cohort, additional analyses of stored serum samples, and linkage to outcome information available in the USRDS to accomplish the following specific aims: Aim 1: Elucidate the underpinnings of physical frailty among patients on hemodialysis and identify potentially remediable correlates. Aim 2: Determine trajectories of frailty, focusing on risk factors for development and resolution of frailty. Aim 3: Determine the extent to which frailty predicts adverse outcomes, including death, hospitalization, development of disability, transition to a higher level of care, falls, and fractures.

 描述(申请人提供)：尽管虚弱通常被认为是一种老年综合征，但患有包括慢性肾脏疾病(CKD)在内的慢性疾病的人有过早虚弱的风险。许多接受血液透析的患者身体虚弱，包括相当大比例的65岁以下患者。虚弱是由于多种生理系统的累积衰退导致的一种综合征，导致体内平衡储备受损，承受压力的能力下降。脆弱的操作定义各不相同，但出现了两种一般方法：赤字累积法，将个人的损伤和状况相加，以创建脆弱指数和身体脆弱表型，其特征是一系列组成部分，包括体重减轻、疲惫、缺乏体力活动、身体表现差或自我报告的身体机能或其各种代用品。虚弱与不良后果的风险更高有关，如社区老年人和接受维持性透析的患者的住院和死亡，他们的虚弱患病率甚至远远高于一般老年人口。探索透析人群脆弱相关性的研究集中在脆弱表型方法上，强调人口统计学和共病，而不是潜在的可改变的危险因素或病理生理学。具体地说，炎症、激素异常、液体超载、肌动蛋白和多药联用的潜在作用一直未得到充分研究，尽管它们具有补救的潜力。此外，脆弱通常被视为一种状态状态，研究在对脆弱进行单一基线评估后确定结果。更好地了解脆弱性的发展，以及在某些情况下解决脆弱性，可能有助于更好地了解其预防和治疗。最后，对脆弱的不同定义或单个组件提供的预后信息进行了很少的比较 终末期肾病(ESRD)患者的脆弱结构。这项应用的目的是彻底描述血液透析患者的脆弱性-其起源和临床相关性，其轨迹，以及与其发展和解决相关的因素。进行这些分析的理由是收集可用于预防或减轻脆弱性及其后遗症的信息。我们建议利用USRDS特殊研究队列中收集的数据，对存储的血清样本进行额外的分析，并与USRDS中提供的结果信息相联系，以实现以下特定目标：目标1：阐明血液透析患者身体虚弱的基础，并确定潜在的可补救的相关性。目标2：确定脆弱性的发展轨迹，重点关注发展和解决脆弱性的风险因素。目标3：确定虚弱在多大程度上预测不良后果，包括死亡、住院、残疾发展、过渡到更高水平的护理、跌倒和骨折。