Frailty is when a person is at higher risk of illness or injury due to having multiple diseases, disabilities or symptoms (such as weight loss). People living with frailty are more vulnerable to illnesses or injury. They may require additional care when suffering a period of ill-health. They may also take longer to recover and may not get back to their previous level of physical ability. Older age is a risk factor for frailty, though younger people can become frail too, especially if they have chronic health conditions such as chronic kidney disease
This study looks at the link between chronic kidney disease (CKD) (where the kidneys stop removing toxins from the blood properly), frailty and mortality (rate of death). Comparing people living with CKD with people living without CKD, we want to see how common frailty is, how quickly frailty develops and whether how frail you are is linked to how long you might live.
Information collected by GPs on patients diagnoses and symptoms can be used to create a score called the electronic Frailty Index or eFI. The eFI is a useful way of identifying if a patient is frail and can even give an indication of how frail they are.
This study will provide important information about if and when we should screen people with kidney disease for frailty. It will also help us to decide when and how we might intervene to prevent frailty, or support those who are living with frailty and kidney disease.
The purpose of this study is to explore associations between reduced renal function (i.e. chronic kidney disease (CKD), frailty and mortality in a UK population. A random selection of patients will be taken who were present in CPRD between January 2006 and December 2015 who had a least two serum creatinine levels recorded and were ?40 years old. The main objective is to investigate the association between stages of CKD and the development of frailty using the electronic Frailty Index (eFI). Renal status will be modelled as a time varying covariate in a cause specific competing risk survival analysis, using flexible parametric models to estimate time to occurrence of frailty and separately, death. Participants with frailty at baseline will be excluded.
For our secondary analyses, in people with CKD and non-CKD (stages 3a to 5) we will also use frailty category as a time varying covariate to investigate all-cause and cardiovascular mortality, as well as time to transplant or dialysis in participants with and without CKD by frailty category
Additionally we will calculate the prevalence of frailty in CKD and non-CKD groups at baseline. We will also identify which of the 35 remaining frailty deficits are most prevalent in frail CKD patients.
For this analysis Hospital Episode Statistics (HES) data will be used to provide more complete information on patient ethnicity and CKD related outcomes, and Office of National Statistics (ONS) death registration data will be used to identify the outcomes of all-cause and cardiovascular mortality.
Our main outcome is development of frailty in CKD and non-CKD cohorts, stratified by CKD stage With frailty defined as eFI ? 0.13 and CKD as eGFR < 60, with no Read/ ICD 10 codes indicating dialysis or kidney transplant.
Our secondary outcomes are all-cause and cardiovascular mortality in a CKD an non-CKD population by frailty level, and rates of dialysis and kidney transplant, in a cohort with CKD, by frailty level.
Prevalence of frailty in the CKD and non-CKD cohorts
Alice Smith - Chief Investigator - University of Leicester
Joanne Miksza - Corresponding Applicant - University of Leicester
Andrew Nixon - Collaborator - Lancashire Teaching Hospitals
Claire Lawson - Collaborator - University of Leicester
Francesco Zaccardi - Collaborator - University of Leicester
Hannah Young - Collaborator - University Hospitals Of Leicester
Kamlesh Khunti - Collaborator - University of Leicester
Thomas Wilkinson - Collaborator - University of Leicester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation