Frailty Among Patients With ADPKD

Autosomal dominant polycystic kidney disease (ADPKD) is a major inherited cause of end-stage kidney disease (ESKD), associated with various systemic complications. Frailty, a degenerative condition linked to adverse health outcomes, may be influenced by ADPKD and its complications; however, data on this association is limited. This study investigated whether ADPKD is associated with increased risk of incident or worsening frailty.

We conducted a retrospective cohort study, using the National Taiwan University Hospital Integrate Medical Database (2006-2021). Adults with ADPKD or simple kidney cysts (SKCs) were identified. After applying exclusion criteria and 1:4 propensity score (PS) matching, 775 patients with ADPKD and 3100 matched SKC controls were included. Frailty status was assessed using the FRAIL scale. Kaplan-Meier curves and Cox proportional hazards were used to evaluate associations with incident and worsening frailty, adjusting for clinical variables. Competing risk analysis accounting for mortality or ESKD was performed.

Over 4.8 years of follow-up, 88 participants (2.3%) developed incident frailty and 810 (20.9%) experienced worsening frailty. ADPKD was not significantly associated with higher risk of incident frailty (hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 0.69-2.08) or worsening frailty (HR: 0.98, 95% CI: 0.82-1.17). Results remained consistent across subgroups stratified by age, kidney function, and baseline frailty, and after accounting for competing mortality or ESKD.

In this matched cohort study, ADPKD was not associated with an increased risk of incident or worsening frailty. These findings suggest that ADPKD may not independently drive functional decline beyond its impact on kidney function.