Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under-recognized complication of diabetes mellitus (DM). Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear.
From the longitudinal cohort of diabetes patients (LCDP) (n = 840,000), we identified adults with DKD, dividing them into those without and with different severities of frailty based on the FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty-associated risk of delirium/cognitive impairment, identified using approaches validated by others.
Totally 149,145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0%, and 1.3% did not have or had 1, 2, and > 2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, comorbidities, medications and interventions, patients with DKD and 1, 2, and > 2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2, and > 2 items, hazard ratio [HR] 1.18, 1.26, and 1.30, 95% confidence interval [CI] 1.08 – 1.28, 1.14 – 1.39, and 1.10 – 1.55, respectively). For every FRAIL item increase, the associated risk rose by 9%.
Frailty significantly increased the risk of delirium/cognitive impairment among patients with DKD. Frailty screening in these patients may assist in delirium risk stratification.

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