Kidney Week

Abstract: SA-PO915

The Impact of Frailty on Technique Failure and Mortality in Patients on Home Dialysis

Session Information

• Dialysis: Home Hemodialysis
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 702 Dialysis: Home Hemodialysis

Authors

• Brar, Ranveer Singh, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Ranveer Singh Brar,

• Whitlock, Reid, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Reid Whitlock,

• Lerner, Blake, University of Manitoba, Winnipeg, Manitoba, Canada

Blake Lerner,

• Bohm, Clara, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Clara Bohm,

• Komenda, Paul, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Paul Komenda,

• Rigatto, Claudio, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Claudio Rigatto,

• Prasad, Bhanu, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada

Bhanu Prasad,

• Thorsteinsdottir, Bjoerg, Mayo Clinic, Rochester, Minnesota, United States

Bjoerg Thorsteinsdottir,

• Tangri, Navdeep, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada

Navdeep Tangri,

Background

Patients on home based dialysis therapies will experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. The aim of the study was to investigate the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies.

Methods

We studied 109 prevalent patients from the Peritoneal Dialysis (PD) and Home Hemodialysis (HHD) programs at our institution between 2012 and 2016. We collected objective [Fried criteria and Short Physical Performance Battery (SPPB)], and subjective measures (physician and nurse impression) of frailty. Our primary outcome was a composite of technique failure, defined as a permanent transition (> 30 days in duration) to facility based hemodialysis or all cause death. The association between different frailty assessment tools and the primary composite outcome was evaluated using Cox proportional hazards models.

Results

Frail status, as determined by the Fried criteria and physician impression was associated with a greater than two-fold increase in risk of our composite outcome (HR: 2.10 [95% CI 1.09-3.99], 2.15 [95% CI: 1.15-4.00, respectively] in models adjusted for age, sex and comorbidity. Weakness and weight loss subdomains of the Fried criteria were both associated with an increased risk of technique failure or death in adjusted analyses (HR: 2.16 [95% CI: 1.23-3.78], 2.69 [95% CI 1.39-5.40], respectively).

Conclusion

Objective and subjective measures of frailty are associated with a more than two-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management.

Funding

• Government Support - Non-U.S.