title: Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study.
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.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  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).
  
  
  METHODS
  Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio.
  
  
  RESULTS
  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 eGFRcr<60mL/min/1.73m2, 2,480 (50%) had eGFRcys<60mL/min/1.73m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of eGFRcrand eGFRcys<60mL/min/1.73m2were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcrand a strong association with eGFRcysand albumin-creatinine ratio. Frail individuals with eGFRcrof 60 to <75mL/min/1.73m2were frequently reclassified to lower eGFR categories using eGFRcys(49% to 45-<60, 32% to 30-<45, and 3% to <30mL/min/1.73m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants).
  
  
  CONCLUSIONS
  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 eGFRcysversus eGFRcr. 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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: sballew1@jhmi.edu.
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Daya
authors.affiliation: Center for Wireless and Population Health Systems, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA.
authors.forename: Job G
authors.initials: JG
authors.lastname: Godino
authors.affiliation: Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Mara
authors.initials: M
authors.lastname: McAdams-DeMarco
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D050197:Atherosclerosis / Q000453:epidemiology; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000652:urine; D005260:Female; D016330:Frail Elderly; D006801:Humans; D057187:Independent Living; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D019338:Polypharmacy; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: Frailty; albuminuria; biomarker; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); frail; geriatric; older adults; polypharmacy; prefrail; reduced kidney function; serum creatinine; serum cystatin C; urine albumin