Associations between Frailty, Physical Performance, and Renal Biomarkers in Older People with Advanced Chronic Kidney Disease

Purpose: Impaired physical performance and frailty are common in older people with advanced chronic kidney disease but it is unclear which metabolic derangements contribute to these impairments. We therefore examined associations between renal biochemical markers and both physical performance and frailty in older people with advanced chronic kidney disease. Methods: Secondary analysis of data from the BiCARB trial, which enrolled non-dialysing patients aged 60 and over, with chronic kidney disease stage 4/5, with serum bicarbonate <22mmol/L. Participants undertook the Short Physical Performance Battery, maximum grip strength and six-minute walk test at baseline, 3,6,12 and 24 months. Renal biochemistry (serum creatinine, cystatin C, phosphate, bicarbonate), haemoglobin, 25-hydroxyvitamin D and NT-pro-B-type natriuretic peptide were measured at baseline. Associations between baseline renal biochemistry and physical performance, and between baseline biochemistry and the monthly rate of change in physical performance were assessed.Results:We analysed data from 300 participants (mean age 74 years; 86 [29%] women). 148 (49%) were prefrail, 86 (29%) were frail. In multivariable cross-sectional baseline analyses, only age and BMI were significantly associated with baseline short physical performance battery; age, sex, body mass index,NT-pro-BNP and 25-hydroxyvitamin D were significantly associated with baseline six-minute walk distance. No significant associations were found between biochemical markers and change in physical performance over time, except between baseline 25-hydroxyvitamin D concentration and change insix-minute walk distance.Conclusions: Biochemical markers associated with chronic kidney disease did not consistently associate with baseline physical performance or the rate of change of physical performance measures.