Study On The Correlation Between Frailty And Chronic Kidney Disease In Elderly Hospitalized Patients

Objective:This study collected general information and related laboratory indicators of hospitalized elderly patients with chronic kidney disease,and analyzed the correlation between the above factors and the onset of frailty in hospitalized elderly patients with chronic kidney disease,in order to provide reference for clinical physicians and nurses to screen and intervene in frailty prevention.Methods:A total of 210 elderly patients with chronic kidney disease were collected from November 2019 to October 2020 in the Department of Nephrology and Geriatrics of Chengde Central Hospital.Make a questionnaire,including age,sex,white blood cell(WBC),red blood cell(RBC),hemoglobin(Hb),total protein(TP),albumin(ALB),uric acid(UREA),creatinine(CR),cystatin C(cys-c),estimated glomerular filtration rate(e GFR),a total of 13 indicators and establishe a database.The clinical frail scale(CFS)was used to evaluate the frailty condition of elderly patients with chronic kidney disease within 24hours after admission.According to the grade of frailty,210 patients in this study were divided into three groups:non-frailty group,mild to moderate frailty group and severe frailty group.According to the CFS score,the patients were divided into two groups:non-frailty group and frailty group.The effective data obtained after sorting out the survey data were input into the statistical software SPSS26.0 for data analysis.The measurement data were tested by normality test and variance homogeneity test,the measurement data in accordance with normal distribution were expressed by x±s statistics,the independent sample t test was used for the comparison between the two groups,and the one-way ANOVA was used for the comparison among the three groups;the measurement data for non-normal distribution was expressed by M(Q1～Q3),the Wilcoxon rank sum t-est was used for the comparison between the two groups,and the Kruskal-Wallis H test was used for the comparison among the three groups.The counting data were expressed by the number of cases(%),and the comparison between groups was made byχ2 test.ROC curve was used to analyze the diagnostic efficiency of each index.Spearman correlation coefficient was used for correlation analysis.The difference was statistically significant with P<0.05.Results:1.General data comparison:A total of 210 patients were selected,with an average age of 72.0(66.0,81.0)years old,including 107 females and 103males,64 cases(30.5%)in the non-frailty group,78 cases(37.1%)in the mild to moderate frailty group and 68 cases(32.4%)in the severe frailty group.The mean age(years)of the non-frailty group、mild to moderate frailty group and the severe frailty group was 67.0(65.0,71.0)、71(65.8,80.0)、81.0(77.0,84.0),respectively.The age difference among the three groups was statistically significant(P<0.05),but there was no significant difference in sex(P>0.05).2.The status of frailty in the elderly patients of different age groups:113patients aged 65～74,including 57(50.4%)frail patients,70patients aged75～84,including 62(88.6%)frail patients;27 patients aged 85 and over,including 27(100%)frail patients.The prevalence of frailty increased with age growth.3.Comparison of various laboratory indicators of the three groups of patients:red blood cell(RBC),hemoglobin(Hb),total protein(TP),albumin(ALB),blood urea nitrogen(UREA),cystatin C(Cys-c),creatinine(CR),and estimated glomerular filtration rate(e GFR)were statistically different(P<0.05).Pairwise comparison among the three groups showed that there were significant differences in the above 8 indicators between non-frailty group and severe frailty group(P<0.05),there were statistical differences in RBC,Cys-c and e GFR levels in non-frailty group and mild to moderate frailty group(P<0.05),there were statistical differences in RBC,ALB,UREA and Cys-c levels in mild to moderate frailty group and severe frailty group(P<0.05).while white blood cells(WBC),platelets(PLT),and uric acid(UA)were not significantly different among the three groups(P>0.05).4.The results of Spearman correlation coefficient analysis of frailty in hospitalized elderly patients with chronic kidney disease showed:RBC(r_s=-0.832,P<0.001),Hb(r_s=-0.226,P=0.001),TP(r_s=-0.248,P<0.001),ALB(r_s=-0.287P<0.001),e GFR(r_s=-0.362,P<0.001)are negatively correlated with the occurr-ence of frailty,age(r_s=0.563,P<0.001),UREA(r_s=0.343,P<0.001),CR(r_s=0.278,P<0.001),Cys-c(r_s=0.778,P<0.001)were positively correlated with the occurrence of frailty.CKD stage of hospitalized elderly patients with chronic kidney disease was positively correlated with frailty grade(r_s=0.476,P<0.001).5.According to clinical frailty evaluation scale,all patients were divided into non-frailty group and frailty group,including 64 cases(30.5%)in the non-frailty group and 146 cases(69.5%)in the frailty group.The result of comparison between the two groups showed that the differences in age,RBC,Hb,TP,ALB,UREA,CR,Cys-c,and e GFR were statistically significant(p<0.05).Use ROC curve to analyze the diagnostic efficacy of the above indicators in CKD with frailty:RBC,Cys-c,CR combined with Cys-c,UREA combined with Cys-c have a relatively high diagnostic efficiency(AUC>0.9);the diagnostic efficiency of Hb,TP,ALB,UREA,CR,UREA combined with CR is relatively low(0.5<AUC<0.7).Conclusion:1.The prevalence of frailty in elderly hospitalized patients with chronic kidney disease is relatively high.we should attach importance to the assessment of frailty in elderly hospitalized patients with chronic kidney disease,especially elderly chronic kidney disease patients.2.The occurrence of frailty was negatively correlated with RBC,HB,TP,ALB and EGFR,and positively correlated with age,UREA,CR and Cys-C in elderly inpatients with chronic renal disease.3.There is a positive correlation between frailty and severity of CKD in elderly patients with chronic kidney disease.4.The diagnostic effect of RBC,Cys-c,CR combined with Cys-c,UREA combined with Cys-c,on chronic kidney disease combined with frailty is better than other laboratory indicators in this study.It provides a new reference index for clinicians to diagnose frailty in elderly patients with chronic kidney disease.