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Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
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Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study
Shoshana H Ballew1, Yan Chen1, Natalie R Daya1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Summary
Frail individuals often have reduced kidney function, with cystatin C (eGFRcys) revealing more cases than creatinine (eGFRcr). Alternative biomarkers are crucial for safe medication management in this population.
Area of Science:
- Gerontology
- Nephrology
- Pharmacology
Background:
- Frail individuals face higher risks for adverse outcomes, including medication-related issues.
- Kidney function impairment is common in frailty, complicating medication choices and dosing.
- Creatinine-based estimates of kidney function may be inaccurate in frail populations.
Purpose of the Study:
- To investigate the prevalence of reduced kidney function in frail older adults.
- To compare kidney function estimates using serum creatinine (eGFRcr) and serum cystatin C (eGFRcys).
- To assess the implications for medication management in frail individuals.
Main Methods:
- Observational study of 4,987 community-dwelling older adults from the Atherosclerosis Risk in Communities (ARIC) Study.
- Frailty assessed using established criteria (weight loss, slowness, exhaustion, weakness, low physical activity).
- Kidney function measured by eGFRcr, eGFRcys, and urine albumin-creatinine ratio.
Main Results:
- 7% of participants were frail; 45% of frail individuals had reduced eGFRcr, while 77% had reduced eGFRcys.
- Frailty strongly associated with eGFRcys and albuminuria, moderately with eGFRcr.
- Frail individuals showed significant reclassification to lower kidney function categories using eGFRcys compared to eGFRcr.
- Hyperpolypharmacy was more prevalent in frail individuals, increasing risks associated with kidney-cleared medications.
Conclusions:
- Frail individuals exhibit a high prevalence of reduced kidney function, with notable discrepancies between eGFRcr and eGFRcys classifications.
- The study highlights the need for alternative biomarkers to accurately assess kidney function in frail patients.
- Accurate kidney function assessment is vital for safe prescribing and managing medication burden in this vulnerable group.
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