Background
Methods
Study design, setting and participant selection
Outcome measures
Frailty
Statistical methods
Results
Participant characteristics
Non-Frail (n = 128) | Frail (n = 225) | Unadjusted P Value | |
---|---|---|---|
Age (years), mean (SE) | 71.5 (0.9) | 77.7 (0.6) | < 0.001* |
Female, n (%) | 70 (55) | 130 (58) | |
Current or ex-smoker, n (%) | 57 (45) | 125 (56) | |
University/college qualification, n (%) | 43 (34) | 57 (25) | |
Self-reported health problems, n (%) | |||
- Diabetes | 13 (10) | 45 (20) | |
- Heart | 19 (15) | 84 (37) | |
- Stroke | 6 (5) | 32 (14) | |
- Blood vessels or circulation | 19 (15) | 66 (29) | |
- Lung or breathing | 17 (13) | 64 (28) | |
- Liver | 7 (5) | 16 (7) | |
- Joints, bones or muscles | 52 (41) | 161 (72) | |
- Mental health | 14 (11) | 37 (16) | |
Chronic kidney disease stage, n (%) | |||
- CKD G2 | 14 (11) | 17 (8) | |
- CKD G3a | 87 (68) | 123 (55) | |
- CKD G3b | 26 (20) | 68 (30) | |
- CKD G4 | 1 (1) | 17 (8) | |
Laboratory Variables, mean (SE) | |||
- eGFR (mL/min/1.73m2) | 50.9 (0.7) | 45.8 (0.7) | < 0.001* |
- Haemoglobin (g/L) | 137.4 (1.7) | 132.2 (1.1) | 0.01 |
- Albumin (g/L) | 41.4 (0.5) | 39.2 (0.4) | < 0.001* |
Frailty Components, n (%) | |||
- Weakness/slowness | 12 (9) | 179 (80) | |
- Exhaustion | 41 (32) | 208 (92) | |
- Low physical activity | 32 (25) | 172 (76) | |
Slow walking pace, n (%) | 11 (9) | 130 (58) | |
VO2 Peak mL/kg/min, mean (SE) | 33.9 (6.0) | 21.7 (9.1) | < 0.001* |
Total symptoms, mean (SE) | 6.9 (0.3) | 9.2 (0.1) | < 0.001* |
Total symptom score, mean (SE) | 14.6 (0.7) | 24.9 (0.6) | < 0.001* |
SF-12 PCS, mean (SE) | 51.8 (0.6) | 36.4 (0.7) | < 0.001* |
SF-12 MCS, mean (SE) | 53.8 (0.7) | 50.2 (0.7) | < 0.001* |
Symptom-burden and HRQOL in participants with frailty and CKD
Unstandardised β Coefficient | SE | Unadjusted P Value | |
---|---|---|---|
KSQ total frequency score | |||
- Frailty | 9.28 | 1.01 | < 0.001* |
- Age | 0.04 | 0.05 | 0.39 |
- Female | 3.69 | 1.00 | < 0.001* |
- eGFR | −0.15 | 0.05 | 0.004* |
Haemoglobin | 0.03 | 0.03 | 0.41 |
SF-12 PCS score | |||
- Frailty | −13.57 | 1.12 | < 0.001* |
- Age | −0.18 | 0.06 | 0.002* |
- Female | −2.19 | 1.11 | 0.05 |
- eGFR | 0.16 | 0.06 | 0.007* |
- Haemoglobin | −0.02 | 0.03 | 0.48 |
SF-12 MCS score | |||
- Frailty | −3.85 | 1.14 | 0.001* |
- Age | 0.13 | 0.06 | 0.03 |
- Female | −3.80 | 1.09 | < 0.001* |
- eGFR | 0.07 | 0.06 | 0.23 |
- Haemoglobin | 0.01 | 0.03 | 0.80 |
Symptoms experienced frequently by participants with frailty and CKD
Non-Frail (n = 128) | Frail (n = 225) | Difference in Frail vs. Non-Frail (%) | |
---|---|---|---|
Loss of muscle strength, n (%) | 20 (16) | 125 (56) | ↑40% |
Bone/joint pain, n (%) | 44 (34) | 155 (69) | ↑35% |
Breathlessness, n (%) | 13 (10) | 94 (42) | ↑32% |
Tiredness, n (%) | 40 (31) | 137 (61) | ↑30% |
Cramp/muscle stiffness, n (%) | 20 (16) | 98 (44) | ↑28% |
Itching, n (%) | 22 (17) | 92 (41) | ↑24% |
Sleep disturbance, n (%) | 35 (27) | 113 (50) | ↑23% |
Feeling cold, n (%) | 32 (25) | 109 (48) | ↑23% |
Poor concentration, n (%) | 11 (9) | 61 (27) | ↑18% |
Urinary frequency, n (%) | 64 (50) | 145 (64) | ↑14% |
Restless legs, n (%) | 18 (14) | 59 (26) | ↑12% |
Loss of appetite, n (%) | 3 (2) | 29 (13) | ↑11% |
SE | Unadjusted P Value | Odds Ratio | 95% CI | |
---|---|---|---|---|
Itching | ||||
- Frailty | 0.31 | < 0.001* | 3.17 | 1.72–5.84 |
- Age | 0.02 | 0.89 | 1.00 | 0.97–1.03 |
- Female | 0.28 | 0.04 | 0.56 | 0.32–0.97 |
- eGFR | 0.01 | 0.48 | 0.99 | 0.97–1.02 |
- Haemoglobin | 0.01 | 0.37 | 0.99 | 0.98–1.01 |
Sleep disturbance | ||||
- Frailty | 0.29 | < 0.001* | 2.97 | 1.68–5.25 |
- Age | 0.01 | 0.61 | 0.99 | 0.97–1.02 |
- Female | 0.27 | 0.002* | 2.34 | 1.38–3.96 |
- eGFR | 0.01 | 0.37 | 0.99 | 0.96–1.02 |
- Haemoglobin | 0.01 | 0.05 | 1.02 | 1.00–1.04 |
Loss of appetite | ||||
- Frailty | 0.79 | 0.07 | 4.34 | 0.91–20.70 |
- Age | 0.03 | 0.34 | 1.03 | 0.97–1.08 |
- Female | 0.48 | 0.14 | 2.04 | 0.80–5.17 |
- eGFR | 0.02 | 0.05 | 0.96 | 0.92–1.00 |
- Haemoglobin | 0.01 | 0.17 | 0.98 | 0.96–1.01 |
Tiredness | ||||
- Frailty | 0.28 | < 0.001* | 3.90 | 2.25–6.78 |
- Age | 0.01 | 0.02 | 0.97 | 0.94–0.99 |
- Female | 0.26 | 0.01 | 1.97 | 1.17–3.30 |
- eGFR | 0.01 | 0.07 | 0.98 | 0.95–1.00 |
- Haemoglobin | 0.01 | 0.81 | 1.00 | 0.98–1.01 |
Bone/joint pain | ||||
- Frailty | 0.26 | < 0.001* | 3.56 | 2.14–5.92 |
- Age | 0.01 | 0.29 | 1.02 | 0.99–1.04 |
- Female | 0.26 | 0.007* | 2.03 | 1.21–3.40 |
- eGFR | 0.01 | 0.06 | 0.98 | 0.95–1.00 |
- Haemoglobin | 0.01 | 0.72 | 1.00 | 0.98–1.01 |
Poor concentration | ||||
- Frailty | 0.41 | 0.001* | 3.94 | 1.75–8.87 |
- Age | 0.02 | 0.66 | 1.01 | 0.97–1.04 |
- Female | 0.33 | 0.06 | 1.87 | 0.98–3.56 |
- eGFR | 0.02 | 0.48 | 0.99 | 0.96–1.02 |
- Haemoglobin | 0.01 | 0.25 | 1.01 | 0.99–1.04 |
Loss of muscle strength | ||||
- Frailty | 0.32 | < 0.001* | 4.94 | 2.61–9.35 |
- Age | 0.02 | 0.02 | 1.04 | 1.01–1.07 |
- Female | 0.29 | 0.23 | 1.42 | 0.80–2.51 |
- eGFR | 0.02 | 0.04 | 0.97 | 0.94–1.00 |
- Haemoglobin | 0.01 | 0.57 | 1.01 | 0.99–1.02 |
Breathlessness | ||||
- Frailty | 0.40 | < 0.001* | 5.65 | 2.56–12.48 |
- Age | 0.02 | 0.29 | 1.02 | 0.98–1.05 |
- Female | 0.29 | 0.27 | 1.38 | 0.78–2.43 |
- eGFR | 0.01 | 0.68 | 0.99 | 0.97–1.02 |
- Haemoglobin | 0.01 | 0.06 | 0.99 | 0.97–1.00 |
Cramp/muscle stiffness | ||||
- Frailty | 0.34 | < 0.001* | 4.25 | 2.19–8.24 |
- Age | 0.02 | 0.86 | 1.00 | 0.97–1.03 |
- Female | 0.29 | 0.03 | 1.90 | 1.07–3.37 |
- eGFR | 0.02 | 0.26 | 0.98 | 0.96–1.01 |
- Haemoglobin | 0.01 | 0.08 | 1.02 | 1.00–1.04 |
Restless legs | ||||
- Frailty | 0.35 | 0.03 | 2.10 | 1.06–4.17 |
- Age | 0.02 | 0.59 | 1.01 | 0.98–1.04 |
- Female | 0.31 | 0.91 | 1.04 | 0.57–1.89 |
- eGFR | 0.02 | 0.78 | 1.00 | 0.97–1.04 |
- Haemoglobin | 0.01 | 0.86 | 1.00 | 0.98–1.02 |
Feeling cold | ||||
- Frailty | 0.29 | 0.002* | 2.45 | 1.39–4.31 |
- Age | 0.01 | 0.59 | 1.01 | 0.98–1.03 |
- Female | 0.25 | 0.15 | 1.45 | 0.88–2.38 |
- eGFR | 0.01 | 0.20 | 0.98 | 0.96–1.01 |
- Haemoglobin | 0.01 | 0.91 | 1.00 | 0.98–1.02 |
Urinary frequency | ||||
- Frailty | 0.29 | 0.13 | 1.54 | 0.88–2.71 |
- Age | 0.01 | 0.05 | 1.03 | 1.00–1.06 |
- Female | 0.26 | 0.58 | 1.15 | 0.70–1.91 |
- eGFR | 0.01 | 0.44 | 0.99 | 0.96–1.02 |
- Haemoglobin | 0.01 | 0.30 | 1.01 | 0.99–1.02 |
Symptom clusters in non-frail and frail participants with CKD
A. Non-Frail | ||||
Cluster | Symptoms | Rotated Component Coefficient | ||
1 | 2 | |||
Sleep disturbance | Sleep disturbance | 0.874 | ||
Restless legs | 0.783 | |||
Poor concentration | 0.645 | |||
Musculoskeletal/breathlessness | Breathlessness | 0.778 | ||
Bone/joint pain | 0.764 | |||
Cramp/muscle stiffness | 0.687 | |||
B. Frail | ||||
Cluster | Symptoms | Rotated Component Coefficient | ||
1 | 2 | 3 | ||
Frailty | Loss of appetite | 0.715 | ||
Tiredness | 0.697 | |||
Feeling cold | 0.566 | |||
Poor concentration | 0.503 | |||
Sleep disturbance | Urinary frequency | 0.747 | ||
Sleep disturbance | 0.665 | |||
Restless legs | 0.647 | |||
Breathlessness | 0.503 | |||
Musculoskeletal | Cramp/muscle stiffness | 0.865 | ||
Loss of muscle strength | 0.627 | |||
Bone/joint pain | 0.551 |