Related Experiment Video
Updated: Jul 15, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Frailty and Cardiovascular Outcomes in Adults With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC)
Mary Hannan1, Jinsong Chen2, Jesse Hsu3
1Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois.
Insights
Frailty significantly increases cardiovascular risks in adults with chronic kidney disease (CKD). Even prefrailty status elevates the risk of heart failure, atherosclerotic events, and death in this population.
Area of Science:
- Nephrology and Cardiovascular Medicine
- Gerontology and Geriatric Medicine
- Epidemiology and Public Health
Background:
- Frailty is prevalent in chronic kidney disease (CKD) and linked to adverse outcomes in dialysis patients.
- The association between frailty and outcomes in non-dialysis-dependent CKD requires further investigation.
Purpose of the Study:
- To evaluate the relationship between frailty status and cardiovascular events and mortality in adults with CKD.
- To assess the risk associated with both frailty and prefrailty in a non-dialysis-dependent CKD cohort.
Main Methods:
- Prospective cohort study involving 2,539 adults from the Chronic Renal Insufficiency Cohort (CRIC) Study.
- Frailty assessed using 5 criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss.
- Cause-specific hazards models used to analyze associations with atherosclerotic events, heart failure, and mortality over median 11.4-year follow-up.
Main Results:
- At baseline, 12% were frail, 51% prefrail, and 37% nonfrail, with a mean age of 62 years and eGFR of 45.4mL/min/1.73m².
- Compared to nonfrailty, frailty was associated with significantly higher risks of atherosclerotic events (HR 2.03), incident heart failure (HR 2.22), all-cause death (HR 2.52), and cardiovascular death (HR 3.01).
- Prefrailty status also demonstrated increased risks for atherosclerotic events (HR 1.77), incident heart failure (HR 1.39), all-cause death (HR 1.76), and cardiovascular death (HR 1.78).
Conclusions:
- Frailty and prefrailty are significantly associated with increased risks of cardiovascular events and mortality in adults with non-dialysis-dependent CKD.
- Findings highlight the importance of frailty assessment in CKD management.
- Further research is warranted to explore interventions aimed at reducing frailty and improving cardiovascular outcomes in this patient group.
Rationale & Objective:
Frailty is common in individuals with chronic kidney disease (CKD) and increases the risk of adverse outcomes in adults with kidney failure requiring dialysis. However, this relationship has not been thoroughly evaluated among those with non-dialysis-dependent CKD.
Study Design:
Prospective cohort study.
Setting & Participants:
2,539 adults in the Chronic Renal Insufficiency Cohort Study.
Exposure:
Frailty status assessed using 5 criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss.
Outcome:
Atherosclerotic events, incident heart failure, all-cause death, and cardiovascular death.
Analytical Approach:
Cause-specific hazards models.
Results:
At study entry, the participants' mean age was 62 years, 46% were female, the mean estimated glomerular filtration rate was 45.4mL/min/1.73m2, and the median urine protein was 0.2mg/day. Frailty status was as follows: 12% frail, 51% prefrail, and 37% nonfrail. Over a median follow-up of 11.4 years, there were 393 atherosclerotic events, 413 heart failure events, 497 deaths, and 132 cardiovascular deaths. In multivariable regression analyses, compared with nonfrailty, both frailty and prefrailty status were each associated with higher risk of an atherosclerotic event (HR, 2.03 [95% CI, 1.41-2.91] and 1.77 [95% CI, 1.35-2.31], respectively) and incident heart failure (HR, 2.22 [95% CI, 1.59-3.10] and 1.39 [95% CI, 1.07-1.82], respectively), as well as higher risk of all-cause death (HR, 2.52 [95% CI, 1.84-3.45] and 1.76 [95% CI, 1.37-2.24], respectively) and cardiovascular death (HR, 3.01 [95% CI, 1.62-5.62] and 1.78 [95% 1.06-2.99], respectively).
Limitations:
Self-report of aspects of the frailty assessment and comorbidities, which may have led to bias in some estimates.
Conclusions:
In adults with CKD, frailty status was associated with higher risk of cardiovascular events and mortality. Future studies are needed to evaluate the impact of interventions to reduce frailty on cardiovascular outcomes in this population.
Plain-Language Summary:
Frailty is common in individuals with chronic kidney disease (CKD) and increases the risk of adverse outcomes. We sought to evaluate the association of frailty status with cardiovascular events and death in adults with CKD. Frailty was assessed according to the 5 phenotypic criteria detailed by Fried and colleagues. Among 2,539 participants in the CRIC Study, we found that 12% were frail, 51% were prefrail, and 37% were nonfrail. Frailty status was associated with an increased risk of atherosclerotic events, incident heart failure, and death.
More Related Videos
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:28Chronic Kidney Disease III: Interprofessional Care
01:29Acute Kidney Injury III: Clinical Manifestations
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...