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Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study
| Content Provider | Scilit |
|---|---|
| Author | Ballew, Shoshana H. Chen, Yan Daya, Natalie R. Godino, Job G. Windham, B. Gwen McAdams-DeMarco, Mara Coresh, Josef Selvin, Elizabeth Grams, Morgan E. |
| Copyright Year | 2017 |
| Description | Journal: American Journal of Kidney Diseases Background Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals. Study Design Observational study. Setting & Participants 4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013). Predictors Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine $(eGFR_{cr}$) and serum cystatin C level $(eGFR_{cys}$) and urine albumin-creatinine ratio. Outcome Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity). Results 341 (7%) participants were classified as frail, 1,475 (30%) had eGFR_{cr}$<60mL/min/1.73m^{2}$, 2,480 (50%) had eGFR_{cys}$<60mL/min/1.73m^{2}$, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of $eGFR_{cr}$ and eGFR_{cys}$<60mL/min/1.73m^{2}$ were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with $eGFR_{cr}$ and a strong association with $eGFR_{cys}$ and albumin-creatinine ratio. Frail individuals with $eGFR_{cr}$ of 60 to $<75mL/min/1.73m^{2}$ were frequently reclassified to lower eGFR categories using $eGFR_{cys}$ (49% to 45-<60, 32% to 30-<45, and 3% to $<30mL/min/1.73m^{2}$). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants). Limitations Cross-sectional study design. Conclusions Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by $eGFR_{cys}$ versus $eGFR_{cr}$. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263025/pdf http://www.ajkd.org/article/S027263861630525X/pdf |
| Ending Page | 236 |
| Page Count | 9 |
| Starting Page | 228 |
| ISSN | 02726386 |
| e-ISSN | 15236838 |
| DOI | 10.1053/j.ajkd.2016.08.034 |
| Journal | American Journal of Kidney Diseases |
| Issue Number | 2 |
| Volume Number | 69 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2017-02-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: American Journal of Kidney Diseases Chronic Kidney Disease (ckd) Estimated Glomerular Filtration Rate (egfr) Reduced Kidney Function |
| Content Type | Text |
| Resource Type | Article |
| Subject | Nephrology |
