title: The presence of frailty in elderly persons with chronic renal insufficiency.
abstract: BACKGROUND
  Frailty has been defined as a tool to define individuals who lack functional reserve and are at risk for functional decline. We hypothesized that chronic renal insufficiency (CRI) would be associated with a greater prevalence of frailty and disability in the elderly.
  
  
  METHODS
  This cross-sectional analysis used baseline data collected from the Cardiovascular Health Study, which enrolled 5,888 community-dwelling adults aged 65 years or older from 4 clinical centers in the United States. Renal insufficiency is defined as a serum creatinine level of 1.3 mg/dL or greater (> or =115 micromol/L) in women and 1.5 mg/dL or greater (> or =133 micromol/L) in men. Frailty is defined by the presence of 3 of the following abnormalities: unintentional weight loss, self-reported exhaustion, measured weakness, slow walking speed, and low physical activity. Disability is defined as any self-reported difficulty with activities of daily living.
  
  
  RESULTS
  Among 5,808 participants with creatinine levels measured at entry, 15.9% of men (n = 394) and 7.6% of women (n = 254) had CRI. Prevalences of frailty (15% versus 6%; P < 0.001) and disability (12% versus 7%; P = 0.001) were greater in participants with CRI compared with those with normal renal function. After multivariate adjustment for comorbidity, CRI remained significantly associated with frailty (odds ratio, 1.76; 95% confidence interval, 1.28 to 2.41), but not disability (odds ratio, 1.26; 95% confidence interval, 0.94 to 1.69).
  
  
  CONCLUSIONS
  Elderly persons with CRI have a high prevalence of frailty, which may signal their risk for progression to adverse health outcomes. If confirmed in other studies, identification of frailty in patients with CRI may warrant special interventions to preserve their independence, quality of life, and survival.
authors.affiliation: Epidemiology and Biostatistics, University of California, San Francisco, General Internal Medicine Section, Medical Service, San Francisco Veterans Affairs Medical Center San Francisco, CA 94121, USA. shlip@itsa.ucsf.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Catherine
authors.initials: C
authors.lastname: Stehman-Breen
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Xiao
authors.initials: X
authors.lastname: Song
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D014481:United States / Q000453:epidemiology