Kidney360 | 2021
Frailty, age, and post-dialysis recovery time in a population new to hemodialysis
Abstract
Background: Frailty, a phenotype characterized by decreased physiologic reserve and the inability to recover following confrontation with a stressor like hemodialysis, may help identify which incident hemodialysis patients will experience longer post-dialysis recovery times. Recovery time is associated with downstream outcomes including quality of life and mortality. We characterized post-dialysis recovery times among patients new to hemodialysis and quantified the association between frailty and hemodialysis recovery time. Methods: Among 285 hemodialysis patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, frailty was measured using the Fried phenotype. Self-reported recovery time was obtained by telephone interview. We estimated the association of frailty (intermediately frail and frail vs. non-frail) and post-dialysis recovery time using adjusted negative binomial regression. Results: Median time between dialysis initiation and study enrollment was 3.4 months (IQR: 2.7, 4.9) and that between initiation and recovery time assessment was 11 months (IQR: 9.3, 15). Mean age was 55 years, 24% were >65 years, and 73% were African American. 72% of individuals recovered in ≤1 hour, 20% in (1-6] hours, 5% required (6-12] hours, and fewer than 5% required >12 hours to recover. Those with intermediate frailty, frailty, and age ≤65 years had a 2.56-fold (95%CI: 1.45-4.52), 1.72-fold (95%CI: 1.03-2.89), and 2.35-fold (95%CI: 1.44-3.85) risk of longer recovery time independent of demographic characteristics, comorbidity, and dialysis-related factors. Conclusions: In adults new to hemodialysis, frailty was independently associated with prolonged post-dialysis recovery. Future studies should assess the impact of frailty-targeted interventions on recovery time to improve clinical outcomes.