Abstract
Introduction: Frailty (F) refers to the cumulative organic damage caused by aging, as a consequence of a diminished physiological reserve. Frailty’s prevalence is 73% in dialysis. Objectives: Our aim was to identify the prevalence of F in patients starting hemodialysis (HD) or hemodiafiltration online (HDF) treatment. To asses change in frailty during a six-month period of dialysis. Patients and Methods: This prospective cohort study evaluated 67 incident patient starting-HD or HDF at one year, with a follow-up period of at least six months. The frailty was assessed by the Fried frailty method. According to this test, we divided the population in two groups: Pre-frail (0-2) and frail (3-5). Results: Mean age was 64 years, 64% were male and 92% were treated with HD. A total of 35.8% of the patients were admitted to dialysis with a prosthetic or native fistula. The prevalence of F at the beginning of dialysis was 65.7%. The mean value of Charlson index (CHI) was 5.2 ± 2. There was a significant correlation between CHI and frailty test (P<0.0001). Basal F score (n=67) improved after 6 month (n=52): 3 (2-4) versus1 (1-2) (P<0.0001). Hematocrit (28 versus 32% P=0.05) and calcium levels (8.6 and 8.9 mg/dL, P<0.002) also increased after sixth-month. Global mortality was 7.5%. In the multivariate analysis CHI (P<0.001) and albumin (P=0.003) were frailty predictors. Conclusion: The prevalence of F in patients who start dialysis therapy is high. There was an improvement in F score after six-month of dialysis treatment. Patients with higher F score had higher mortality with higher CHI.
Highlights
Frailty (F) refers to the cumulative organic damage caused by aging, as a consequence of a diminished physiological reserve
Frailty syndrome is defined as the cumulative damage of multiple organs and systems secondary to the mere process of aging, which results in a diminished physiological reserve (30%) leading to an inadequate tolerance to internal and external insults [1,2,3,4,5,6,7,8,9]
Variables The quantitative and qualitative variables for each patient where obtained from the EUCLID (European Clinical Database) database, an online program for data recollection of patients admitted for chronic renal replacement therapies (RRTs) of Fresenius dialysis centers
Summary
Frailty (F) refers to the cumulative organic damage caused by aging, as a consequence of a diminished physiological reserve. Disability in senile population was explained exclusively as a consequence of the underlying disease, without finding a physiopathological mechanism that accounted for it, in the absence of an established disease or its relationship with the process of aging itself [1] For this reason, over the past ten years, a new term has emerged, conceptualizing a new characteristic or phenotype, called frailty [1]. Patients who require RRT, other factors such as uremic syndrome and pro inflammatory states are added alongside conditions characteristic to hemodialysis (HD) (vascular access type, dialysis dose (Kt/V), anemia, bone mineral metabolism etc.) [2,10] This syndrome affects a number of physiological areas such as the cognitive, emotional, nutritional, functional, strength, equilibrium, mobility and sleep. The Fried Frail test, is the most tested and applied, using five
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