Supplementary Material for: Progression in Physical Frailty in Peritoneal Dialysis Patients

Background: Physical frailty contributes to adverse clinical outcomes in peritoneal dialysis (PD) patients. Little has been reported about frailty transitions in this population. We aimed to describe the transitions of frailty in PD patients and identify factors that predicted changes in frailty state. Methods: In a prospective observational study, we recruited 267 PD patients. Frailty was assessed by a validated frailty score. Depression was graded by PHQ-9 score, and nutritional status was evaluated by serum albumin, Subjective Global Assessment (SGA), and comprehensive Malnutrition Inflammation Score (MIS). The primary outcome was the change in frailty score at follow-up compared to baseline. Results: At baseline, 194 (72.7%) patients were classified as frail. With time, their frailty scores significantly increased (p p p p p p = 0.001), as well as longer duration of hospitalization (p = 0.001), was independently associated with a greater change in frailty score after adjustment for confounding factors. Frailty score was also improved in patients who were converted to hemodialysis (p = 0.048) and received renal transplantation (p = 0.005). Conclusion: Our findings suggested that frailty transitions were common in PD patients. Worsening in nutrition and depression, together with a longer duration of hospitalization, were associated with worsening in frailty.

背景：躯体衰弱（physical frailty）会增加腹膜透析（peritoneal dialysis, PD）患者的不良临床结局发生风险。目前针对该人群的衰弱状态转归的相关研究报道较为匮乏。本研究旨在描述PD患者的衰弱转归情况，并明确可预测衰弱状态变化的影响因素。

方法：本研究为前瞻性观察性研究，共纳入267例PD患者。采用经过验证的衰弱评分量表评估患者的衰弱程度；抑郁程度采用患者健康问卷-9项（PHQ-9）评分进行评定；营养状态则通过血清白蛋白水平、主观全面评定（Subjective Global Assessment, SGA）以及综合营养不良炎症评分（Malnutrition Inflammation Score, MIS）进行评估。本研究的主要结局指标为随访时衰弱评分相较于基线的变化值。

结果：基线时，194例（72.7%）患者被评定为衰弱。随随访时间推移，患者的衰弱评分显著升高（P<0.001）；在校正混杂因素后，营养状态恶化、抑郁程度加重（P均=0.001）以及更长的住院时长（P=0.001）均与衰弱评分的更大幅度变化独立相关。转至血液透析（hemodialysis, HD）以及接受肾移植的患者，其衰弱评分也得到改善（分别为P=0.048和P=0.005）。

结论：本研究结果显示，PD患者的衰弱状态转归较为常见。营养状态恶化、抑郁程度加重以及更长的住院时长，均与衰弱程度加重相关。