title: Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis.
abstract: OBJECTIVE
  To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single hemodialysis center in Baltimore, Maryland.
  
  
  METHODS
  One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012.
  
  
  METHODS
  Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations.
  
  
  RESULTS
  At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P = .046) and 2.6 times (95% CI = 1.04-6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants.
  
  
  CONCLUSIONS
  Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations.
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Law
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Brian
authors.initials: B
authors.lastname: Boyarsky
authors.affiliation: Nephrology Center of Maryland, Baltimore, Maryland.|Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Dialysis Program, Good Samaritan Hospital, Baltimore, Maryland.
authors.forename: Luis
authors.initials: L
authors.lastname: Gimenez
authors.affiliation: Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.|Nephrology Center of Maryland, Baltimore, Maryland.|Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Dialysis Program, Good Samaritan Hospital, Baltimore, Maryland.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Walston
authors.affiliation: Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate / Q000639:trends