Frailty and Duration of Maintenance Dialysis: A Japanese Nationwide Cross-Sectional Study.

ABSTRACT

RATIONALE & OBJECTIVE: Prolonged end-stage kidney disease (ESKD) is a risk factor for frailty, and the number of patients in Japan receiving maintenance dialysis for more than 20 years is large and growing. This study characterized the association of dialysis vintage and frailty among patients receiving dialysis in Japan. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Patients with ESKD aged over 50 years who received maintenance dialysis in 2018 as represented in the JSDT Renal Data Registry database (n = 227,136). EXPOSURE Dialysis vintage categorized as 0-<5 years, 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years. OUTCOME: Frailty and bedridden status were defined as graded≥2 and graded 4, respectively, according to the Eastern Cooperative Oncology Group Performance Status scale. ANALYTICAL APPROACH: Poisson regression models with robust error variance adjusted for potential covariates were used to estimate the adjusted prevalence ratios (APRs) for frailty and bedridden status. Clinical characteristics of patients undergoing dialysis for≥30 years were also described. RESULTS: Among the study cohort, 5,510 patients (2.4%) had been undergoing dialysis for 30 years or more. The prevalence of frailty in the group with over 30 years of dialysis history was 36.2%, and the rate of being bedridden was 6.4%. Compared with<5 years, dialysis vintages of 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years were associated with frailty (APR, 1.06 [95% CI, 1.05-1.08], 1.10 [95% CI, 1.08-1.11], 1.14 [95% CI, 1.10-1.17], and 1.67 [95% CI, 1.60-1.73]), respectively. Compared with<5 years, dialysis vintages of 5-<10 years, 10-<20 years, 20-<30 years, and over 30 years were associated with being bedridden (APR, 1.17 [95% CI, 1.13-1.22], 1.26 [95% CI, 1.20-1.31], 1.17 [95% CI, 1.08-1.26], and 1.66 [95% CI, 1.49-1.86], respectively. LIMITATIONS: Patients receiving short-term dialysis may have more unmeasured comorbidities compared with patients receiving long-term dialysis. CONCLUSIONS: Long-term dialysis therapy, particularly exceeding 30 years, is associated with deterioration of physical function and frailty. PLAIN-LANGUAGE SUMMARY: End-stage kidney disease increases the risk of frailty. Understanding how long-term dialysis affects physical function may help patients and caregivers plan their lives better. Our research explores the relationship between duration of maintenance dialysis and frailty. We found that longer durations of maintenance dialysis, especially longer than 30 years, were associated with a higher risk of frailty and being bedridden among Japanese patients. The factors responsible for these associations should be the focus of future research.