SAN FRANCISCO—Frailty is "exceptionally common" among kidney patients starting dialysis, researchers reported.

In a prospective observational study, 73 percent of patients starting dialysis met criteria for frailty, according to Yeran Bao, MD, of the University of California San Francisco, and colleagues.

And frailty was independently associated with the risks of both death and hospital admission, Bao and colleagues reported online in Archives of Internal Medicine.

Frailty was also associated with earlier initiation of dialysis, as indicated by a higher estimated glomerular filtration rate (eGFR) among frail patients compared with the non-frail minority, they found.

In recent years, Bao and colleagues noted, there has been a trend toward earlier initiation of dialysis: in 1996, less than 20 percent of patients started dialysis with an eGFR of 10 mL/min/1.73 m² or greater, while by 2009 the proportion was 54 percent.

And several studies have found that a higher eGFR when dialysis is started is associated with increased mortality, even in relatively healthy populations with few comorbidities, they noted.

But it has not been clear why physicians are starting patients on dialysis earlier, although one reason may be the high prevalence of frailty among those with end-stage renal disease (ESRD), Bao and colleagues argued.

To help clarify the issue, they turned to the Comprehensive Dialysis Study, a U.S. cohort that enrolled patients starting dialysis from Sept. 1, 2005 to June 1, 2007. Participants were followed for vital status through Sept. 30, 2009, and for time to first inpatient admission through Dec. 31, 2008.

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