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The frailty risk trajectory associated with kidney and cardiovascular morbidities among patients with incident diabetes: A population-based study

  • Jui Wang
    Affiliations
    Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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  • Szu-Ying Lee
    Affiliations
    Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
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  • Chia-Ter Chao
    Correspondence
    Corresponding author. National Taiwan University Hospital, Taipei, Taiwan.
    Affiliations
    Neprology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Jenq-Wen Huang
    Affiliations
    Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan

    Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Kuo-Liong Chien
    Affiliations
    Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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      Highlights

      • Patients with diabetes mellitus or chronic kidney disease are at risk of frailty.
      • Diabetes predisposes patients to developing cardiovascular morbidities.
      • The influences of CKD or CV morbidities on the course of frailty in diabetic patients remains unclear.
      • Our findings illustrate the effect of CKD and CV morbidities on incident frailty risk.
      • Comorbidities-oriented care strategies potentially reduce frailty risk in these patients.

      Abstract

      Background and aims

      Frailty denotes the increased vulnerability to stressors/insults associated with aging or diseases, and has high incidence in patients with diabetes mellitus (DM). We hypothesized that chronic kidney disease (CKD) and non-kidney morbidities in patients with newly diagnosed DM might modulate their risk of developing incident frailty.

      Methods

      From the Longitudinal Cohort of Diabetes Patients, we identified 322,109 patients with newly diagnosed DM, and classified them into those without CKD, with CKD before and after DM. We used Kaplan-Meier analyses and Cox proportional hazard regression to analyze associations between CKD or non-kidney morbidities and the risk of incident frailty. We further analyzed the year-to-year trend of frailty risk brought by CKD or non-kidney morbidities.

      Results

      Patients with DM but without CKD (n = 249,752; 77.5%), with CKD prior to (n = 23,829; 7.4%), and after DM (n = 48,528; 15.1%) were enrolled. Those with CKD, regardless of onset timing, had a significantly higher risk of developing frailty than those without (for onset prior to DM, hazard ratio (HR) 1.235, 95% confidence interval (CI) 1.11–1.38; for onset after DM, HR 1.386, 95% CI 1.21–1.59). The risk was more prominent early after the diagnosis of DM was made. Patients with chronic obstructive pulmonary disease, liver, and cardiovascular morbidities all had a significantly higher risk of frailty than those without, with cerebrovascular accident carrying the most prominent risk elevation (HR 4.059, 95% CI 3.73–4.42).

      Conclusions

      CKD regardless of onset timing relative to DM predicted a higher risk of incident frailty, while non-kidney morbidities including cardiovascular morbidities, similarly increased frailty risk among incident diabetic patients.

      Graphical abstract

      Keywords

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