|Title:||Frailty predicts an increased risk of end-stage renal disease with risk competition by mortality among 165,461 diabetic kidney disease patients||Authors:||CHIA-TER CHAO
|Issue Date:||2019||Publisher:||International Society on Aging and Disease||Journal Volume:||10||Journal Issue:||6||Start page/Pages:||1270-1281||Source:||Aging and Disease||Abstract:||
To examine the effect of frailty on diabetic kidney disease patients' risk of progression to end-stage renal disease (ESRD), mortality, and adverse episodes, as whether frailty modifies their risk of developing ESRD and other adverse outcomes remains unclear. We identified 165,461 DKD patients from the Longitudinal Cohort of Diabetes Patients in Taiwan (n=840,000) between 2004 and 2010, classifying them into those without frailty or with 1, 2 and ?3 frailty components based on a modified version of FRAIL scale. Using Cox proportional hazard regression analysis, we examined the long-term risk of developing ESRD along with their risk of mortality, supplemented by a competing risk analysis against mortality. Among all participants, 66.2% (n=109,586), 27.2% (n=44,986), 5.9% (n=9,799), and 0.7% (n=1090) patients did not have or had 1, 2, and ?3 frailty components, respectively. After a 4.1-year follow-up, 4.2% patients developed ESRD and 18.5% died. Cox proportional hazard modeling revealed that patients with 1, 2, and ?3 frailty components had increased risks of developing ESRD (for 1, 2, and ?3 components, hazard ratio [HR] 1.13, 1.18, and 1.2, respectively) and mortality (HR 1.25, 1.41, and 1.34, respectively), with. 9% and 16% risk elevations for ESRD and mortality per component increase. Competing risk analysis showed that frailty-induced ESRD risk was attenuated partially by mortality in those with moderate frailty. The receipt of palliative care did not attenuate this risk. Frailty increased the risk of ESRD based on a dose-response relationship among DKD patients with risk competition by mortality. ? 2019 Chao CT et al.
|ISSN:||2152-5250||DOI:||10.14336/AD.2019.0216||SDG/Keyword:||2,4 thiazolidinedione derivative; acetylsalicylic acid; allopurinol; alpha glucosidase inhibitor; angiotensin receptor antagonist; antidepressant agent; benzodiazepine; beta adrenergic receptor blocking agent; biguanide; clopidogrel; dipeptidyl carboxypeptidase inhibitor; dipeptidyl peptidase IV inhibitor; fibric acid derivative; insulin; meglitinide; neuroleptic agent; nonsteroid antiinflammatory agent; sulfonylurea; warfarin; adult; aged; Article; body weight loss; cohort analysis; comorbidity; diabetes mellitus; diabetic nephropathy; diabetic patient; disease classification; disease exacerbation; end stage renal disease; fatigue; female; frailty; human; longitudinal study; major clinical study; male; middle aged; mobilization; mortality; palliative therapy; predictive value; retrospective study; risk assessment; survival rate
|Appears in Collections:||醫學系|
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