Frailty in Hemodialysis Patients: A Study from Two Tertiary Care Dialysis Units

Abstract

Background: Frailty is common in elderly individuals and is an important parameter predicting mortality. Multiple factors are responsible for this clinical syndrome and many are present in patients undergoing hemodialysis. Understanding the prevalence and factors associated with frailty in maintenance hemodialysis patients helps us to prognosticate and offer interventions in this vulnerable group. Aims and Objectives: ( 1) To study the prevalence of frailty in two quaternary maintenance hemodialysis units, (2) to understand factors that correlate with frailty, and (3) to look at the short-term impact of frailty on hospitalization and mortality in this cohort. Materials and Methods: A prospective study in two hemodialysis centers was conducted over a period of 6 months. Data on demographics, comorbid conditions, laboratory parameters, and nutritional parameters were collected. Nutritional assessment included information from 7-point subjective global assessment and Global Initiative on Malnutrition (GLIM). Data were also collected regarding the body composition analyses of these patients. Frailty was assessed by using the Fried’s classification. Data analysis was done looking at the prevalence of frailty in this cohort and factors associated with frailty. The cohort was followed up for another 6 months and survival outcome during this follow-up was recorded. Follow-up data were analyzed to look at the impact of frailty on short-term survival. Results: A total of 121 maintenance hemodialysis patients were included in the study. There were 44 (36%) females in the observational cohort. The mean (±standard deviation [SD]) age of the cohort was 56.59 (±13.58) years. The mean (± SD) dialysis vintage was 28.42 (±28.67) months. Sixty-eight (56.2%) patients had Type 2 diabetes mellitus and 111 (91.7%) had hypertension. Frailty (based on Fried’s classification) was seen in 107 (88.4%) patients. The incidence of frailty was distributed across all ages. There was also no significant association between frailty and nutritional parameters. Patients on thrice-weekly dialysis were found to have a higher incidence of frailty (P = 0.01). The presence of frailty did not impact short-term hospitalization and mortality. Discussion: There is a high incidence of frailty in hemodialysis patients across all ages. The underlying comorbidities and the repeated stress of the hemodialysis procedure make frailty prevalent in younger individuals, as was noted in our study. The incidence of frailty was more in patients on thrice-weekly dialysis. Frailty was not associated with hospitalizations and short-term mortality in our cohort. Conclusions: There is a high incidence of frailty across all ages in hemodialysis patients and should be assessed in all hemodialysis patients, risk factors identified, and appropriate therapeutic interventions instituted in these vulnerable patients.