Johns Hopkins scientists report that a 10-minute test for frailty, first designed to predict whether the elderly can withstand surgery and other physical stress, could be useful in assessing the increased risk of death and frequent hospitalization among dialysis patients of any age.
In a study described in the Journal of the American Geriatrics Society and published online, the investigators said dialysis patients deemed frail by the assessment were more than twice as likely to die within three years, and much more likely to be hospitalized repeatedly. Results of the frailty test, which measures physiological reserve, suggest that kidney failure patients who submit to the long and arduous process of mechanical blood cleansing several days a week are undergoing a premature aging process detrimental to their health, the researchers said.
Frailty was measured using a five-point scale developed at Johns Hopkins. Patients are classified as frail if they meet three or more of the following criteria: shrinking (unintentional weight loss of 10 or more pounds in the previous year); weakness (decreased grip strength as measured by a hand-held dynamometer); exhaustion (measured by responses to questions about effort and motivation); reduced physical activity (determined by asking about leisure time and activities); and slowed walking speed (the time it takes to walk 15 feet).
Study leader Dorry L. Segev, MD, PhD and his team enrolled 146 hemodialysis patients between January 2009 and March 2010, and followed them through August 2012. At enrollment, 50% of the participants who were 65 and older, and 35% those under 65, were measured as frail. The three-year mortality rate for frail participants was 40%, compared to 16.2% for the non-frail. Of those hospitalized more than twice over the study period, 43% were frail, while only 28% were not frail.
“We’re learning that lessons from gerontology can help us understand younger patients with chronic diseases,” Segev says.