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Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study.

TitleFrailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsBallew SH, Chen Y, Daya NR, Godino JG, B Windham G, McAdams-DeMarco M, Coresh JJ, Selvin E
Secondary AuthorsGrams ME
JournalAm J Kidney Dis
Volume69
Issue2
Pagination228-236
Date Published2017 Feb
ISSN1523-6838
KeywordsAged, Albuminuria, Atherosclerosis, Biomarkers, Creatinine, Cross-Sectional Studies, Cystatin C, Female, Frail Elderly, Humans, Independent Living, Kidney, Kidney Function Tests, Male, Polypharmacy, Risk Factors
Abstract

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) and serum cystatin C level (eGFR) 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

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 versus eGFR. 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.

DOI10.1053/j.ajkd.2016.08.034
Alternate JournalAm J Kidney Dis
PubMed ID27884475
PubMed Central IDPMC5263025
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
U01 HL096812 / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
U01 HL096917 / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
R01 DK089174 / DK / NIDDK NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
U01 HL096902 / HL / NHLBI NIH HHS / United States
K01 AG043501 / AG / NIA NIH HHS / United States
N01 HC055019 / HC / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
K24 DK106414 / DK / NIDDK NIH HHS / United States
U01 HL096814 / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
R01 HL070825 / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
U01 HL096899 / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
K08 DK092287 / DK / NIDDK NIH HHS / United States
R01 DK100446 / DK / NIDDK NIH HHS / United States