THE ASSOCIATION BETWEEN URINE ALBUMIN AND ESTIMATED GLOMERULAR FILTRATION RATE WITH INCIDENT FRAILTY IN HEALTHY OLDER ADULTS: SECONDARY ANALYSIS OF THE ASPREE TRIAL COHORT
Dr Elisa Bongetti1,2, Anna Wilkinson3,4,5, James Wetmore6, Dr Anne Murray7, Robyn Woods3, Sara Espinoza8,9, Michael Ernst10,11, Michelle Fravel10, Suzanne Orchard3, Le Thi Phuong Thao3, Joanne Ryan3, Rory Wolfe3, Kevan Polkinghorne1,2,3
1Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Australia, 2Department of Medicine, Monash University, Melbourne, Australia, 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 4Disease Elimination, Burnet Institute, Melbourne, Australia, 5Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia, 6Division of Nephrology, Hennepin Healthcare, Minneapolis, USA, 7Berman Center for Outcomes and Clinical Research and Department of Medicine, Hennepin Healthcare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare Minneapolis, Minneapolis, USA, 8Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health , San Antonio, USA, 9Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA, 10Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa , Iowa City, USA, 11Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, USA
Aim: To investigate whether abnormal kidney function is associated with incident frailty assessed by the modified Fried frailty phenotype (FP), and, separately, a deficit accumulation frailty index (FI).
Background: Identifying risk factors for frailty may facilitate early diagnosis and intervention to preserve functional status. The association between estimated glomerular filtration rate (eGFR) and albuminuria (spot urine albumin to creatinine ratio, UACR) with incident frailty in generally healthy older individuals is unclear.
Methods: This was a secondary analysis of 16,965 non-frail older adults aged ≥65 years in the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial cohort. Primary exposures were eGFR and UACR. Missing data in the FP was managed with multiple imputation. The primary outcome was time to incident frailty, analysed using multivariable adjusted discrete time survival analyses.
Results: The mean age was 75.0 ± 4.5 years, median eGFR 78.5mL/min/1.73m2 (IQR 67.5, 89.3), and the median UACR was 0.80 mg/mmol (IQR 0.50, 1.50). In analyses using the FP, 950 people developed frailty over a median follow-up of 4.7 years (IQR 3.0, 5.0). Using the FI, 2,338 developed frailty over a median of 4.0 years (IQR 3.0, 5.0). The relationships between eGFR and both incident FP and FI was non-linear, such that an eGFR <45 or ≥75mL/min/1.73m2 was significantly associated with an increased risk of incident frailty. For every doubling of baseline UACR, risk of incident frailty increased by 4% using the FP (HR: 1.04, 95%CI:1.02-1.07) and the FI (HR: 1.04, 95%CI:1.01-1.07).
Conclusions: In older adults, doubling of UACR, even at very low levels, was independently associated with incident frailty. Both low and high eGFR were associated with increased risk of incident frailty.
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Biography:
Elisa is an early career nephrologist at Monash Health and a full time PhD candidate at Monash University. Her thesis examines long-term health outcomes associated with measures of kidney function in older adults.