y was pursued.When older adults with CKD and their families face treatment decisions, clinicians should utilize walking speed to frame discussions of prognosis. Background Accurate mortality prediction can guide clinical care for older adults with CKD. Yet existing tools do not incorporate physical function, an independent predictor of death in older adults. We determined whether incorporating physical function measurements improve mortality prediction among older adults with CKD. Methods We included Chronic Renal Insufficiency Cohort participants who were 65 years and older, had eGFR <60 ml/min per 1.73 m2, not receiving kidney failure with replacement therapy (KFRT), and had least one gait speed assessment. Gait speed was measured at usual pace (≥0.84, 0.83–0.65, 0.64–0.47, ≤0.46 m/s, or unable), and frailty was assessed using Physical Frailty Phenotype criteria (range 0–5 points, also known as Fried criteria). We modeled time to all-cause death over 5 years using Cox proportional hazard models, treating KFRT as censored and noncensored events in separate analyses. C-statistics assessed model discrimination. Results Among 2338 persons, mean age was 70±4 years, 43% were female, and 43% were Black. Mean eGFR was 42±13 ml/min per 1.73 m2, and median urine albumin-to-creatinine ratio was 33 mg/g (Q1 9, Q3 206). Over a median follow-period of 5 years, 392 died and 164 developed KFRT. In censored analyses, adding gait speed or frailty improved mortality risk prediction. The C-statistic changed from 0.69 to 0.72 with gait speed scores and from 0.70 to 0.73 with frailty scores. The performance of models with gait speed or frailty was similar in noncensored analyses. Conclusions Among older adults with CKD, adding measures of physical function modestly improves mortality prediction....

中文翻译：

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慢性肾病老年人的身体功能和死亡率


y 被追捕。当 CKD 老年患者及其家人面临治疗决策时，临床医生应利用步行速度来讨论预后。背景 准确的死亡率预测可以指导 CKD 老年人的临床护理。然而，现有的工具并未纳入身体机能，而身体机能是老年人死亡的独立预测指标。我们确定了结合身体功能测量是否能改善 CKD 老年人的死亡率预测。方法 我们纳入了 65 岁及以上的慢性肾功能不全队列参与者，eGFR <60 ml/min/1.73 m2，未接受肾衰竭替代疗法 （KFRT），并且至少进行了一次步态速度评估。以正常速度（≥0.84、0.83-0.65、0.64-0.47、≤0.46 m/s 或无法）测量步态速度，并使用身体虚弱表型标准（范围 0-5 分，也称为 Fried 标准）评估虚弱。我们使用 Cox 比例风险模型对 5 年内全因死亡的时间进行建模，在单独的分析中将 KFRT 视为删失和非删失事件。C-统计量评估模型鉴别度。结果 2338 例患者平均年龄 70±4 岁，女性占 43%，黑人占 43%。平均 eGFR 为 42±13 ml/min / 1.73 m2，中位尿白蛋白/肌酐比值为 33 mg/g （Q1 9， Q3 206）。在中位 5 年的随访期内，392 例死亡，164 例发展为 KFRT。在删失分析中，增加步态速度或虚弱可以提高死亡风险预测。步态速度评分的 C 统计量从 0.69 变为 0.72，虚弱评分的 C 统计量从 0.70 变为 0.73。在非删失分析中，步态速度或虚弱的模型的表现相似。 结论 在患有 CKD 的老年人中，增加身体机能指标可适度改善死亡率预测。