Physical frailty transitions in patients with CKD: instability and limited impact on adverse health outcomes

Abstract

Objective This study aimed to evaluate the association between frailty transitions and the development of health outcomes in patients with non-dialysis CKD. Methods Prospective longitudinal study that included individuals with CKD stages 3b to 5, on non-dialysis treatment, aged≥18 years and of both sexes. Clinical, demographic and laboratory data were collected and frailty was assessed using the physical phenotype tool. Individuals with ≥3 points were considered frail, 1 to 2 points as pre-frail and 0 points as robust. To assess the frailty transition, the scale was applied at the time of study entry (M0) and after 14 months (M1). Subsequently, individuals were classified into three groups: improvement, maintenance or worsening of frailty. Patients were followed for 18 months to verify outcomes. Results Ninety-five patients were included, with a median age of 63 (55–71) years, 56.8% were male. At M0, 25% (n:24) had physical frailty, 63% (n:60) were pre-frail and 12% (n:11) were robust. Approximately 56% (n:53) of the participants maintained their frailty status, 23% (n:22) had improvement and 21% (n:20) had a decline. There was no association between the transition of frailty and hospitalization (p=0.777), entry into dialysis (p=0.781), mortality (p=0.430) and combined outcomes (p=0.534). Conclusions We did not observe an association between the transition of frailty and the health outcomes evaluated. Transition between states of physical frailty occurred in most individuals with CKD, suggesting that the condition is unstable even over a short period of time and can be severe even in young adults.