Frailty may increase the risk for urinary tract infection (UTI) in patients with diabetes and chronic kidney disease (CKD), a new study finds.
Diabetes already places a patient at risk for UTI, and the impaired immunity of CKD hinders response to infections. Frailty might add to these vulnerabilities, according to investigators.
Among 79,887 patients with diabetes and CKD in the Longitudinal Cohort of Diabetes Patients, 50.3%, 12.8%, and 0.8% had 1, 2, and 3 or more items on the modified FRAIL scale, respectively, at baseline. The F-R-A-I-L scale measures deficits in 5 domains: Fatigue, Resistance, Ambulation, Illnesses, and Loss of body weight. The researchers broadened the definition of each domain (except for illnesses) to capture related complaints, such as diagnosis codes for weakness, falling, poor gait, malnutrition, and muscle wasting.
According to an adjusted Cox proportional hazard model, more severe frailty predicted higher risk for UTI. The risk for UTI significantly increased 19%, 24%, and 43% in patients with 1, 2, and 3 or more FRAIL items, respectively, compared with no FRAIL items, Jenq-Wen Huang, MD, of National Taiwan University Hospital in Taiwan and colleagues reported in BMC Geriatrics. Each additional item increased the risk for UTI by 11%. Results were consistent across sex, age (younger vs older than 65 years), and CKD stage 1-4. Whether frailty correlates with urosepsis was less clear.
“Judging from the fact that UTI aggravates renal outcomes in patients with CKD and consumes excessive healthcare resources in patients with [diabetes mellitus] and CKD, it would be prudent to screen for frailty in these patients and provide them with optimal frailty-directed management in order to attenuate their risk of UTI and improve their outcomes,” according to Dr Huang’s team.
The investigators explained that patients with frailty frequently have co-existing malnutrition, sarcopenia, cognitive dysfunction, depression, and urolithiasis, which each contribute to UTI risk through mechanisms such as waning immunity, immobilization, urine retention, dehydration, and anatomical defects.
To reduce risk for frailty, Dr Huang’s team suggested optimizing physical activity and protein intake, and avoiding potentially inappropriate medication prescription in each individual patient.
A report from the ethnically-diverse CRIC (Chronic Renal Insufficiency Cohort) Study recently published in Kidney Medicine highlighted the importance of social support. In the study of 1851 patients older than 65 years with nondialysis-dependent CKD, higher social support was associated with 77% increased odds of being non-frail, according to Edward Horwitz MD, of Case Western Reserve University in Cleveland, Ohio, and colleagues. It was also associated with better cognitive function and health-related quality of life. Higher social support was defined as a score higher than 12 (out of a possible 30) on the Lubben Social Network scale.
According to the CRIC investigators, “strong social support may modify the susceptibility of frail CKD patients to adverse outcomes by allowing for more access to medical care or improving treatment adherence.” Social support may be improved by interventions such as home visiting, social activity, and physical activity programs, and groups centered on self-management, counseling, and discussion, they added.
Chao C-T, Lee S-Y, Wang J, Chien K-L, Huang J-W, et al. Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr. 2021 Jun 7;21(1):349. doi:10.1186/s12877-021-02299-3
Slaven A, Hsu J, Schelling JR, et al; on behalf of the CRIC study investigators. Social support in older adults with CKD: a report from the CRIC (Chronic Renal Insufficiency Cohort) Study. Kidney Med. Published online July 19, 2021. doi:10.1016/j.xkme.2021.04.025