WASHINGTON—Frailty is common among patients on hemodialysis (HD), and new research suggests that it is associated with a deterioration of quality of life over time, according to a poster presentation at the American Society of Nephrology’s Kidney Week 2019 meeting.
A team led by Bhanu Prasad, MD, of Regina General Hospital in Regina, Saskatchewan, Canada, assessed frailty in 100 prevalent HD patients at their institution (mean age 63 years; 51% diabetic; 58% male; 73% white) over 1 year. At baseline, two-thirds of patients were frail, with a Fried score of 3, 4, or 5 out of 5 physical criteria. A total of 69% had cognitive impairment based on the Montreal Cognitive Assessment tool, and 53% screened positive for depressive symptoms on the Geriatric depression scale. The median EuroQol-5-Dimensions-3 Levels (EQ-5D-3L) utility score was 0.81 and EQ-Visual Analog Scale (EQ-VAS) was 60.
Most patients (82%) were fully independent, whereas 17% were independent with family support. Only 1% of patients received home care. Sixty-five patients completed a follow-up assessment at 1 year.
At 1 year, more patients overall had difficulty with mobility (83.1% vs 67.7%) and self-care (18.5% vs 6.2%). Fewer were fully independent (63.1% vs 81.5%) and median quality of life was lower (0.77 vs 0.81). Patients who had cognitive impairment at baseline showed further decline at 1 year, which potentially affected their ability to adhere to HD schedules and fluid and dietary restrictions.
By 1 year, more patients met frailty criteria (67.7% vs 64.6%). At this point, frail patients were more likely than nonfrail patients to be dependent on family members or require multiple support systems. Frail patients were also more likely to have difficulty with self-care, daily activities, mobility, pain, and anxiety. Of the 22 patients who died, 62% were deemed frail.
“The collective impact of multiple comorbidities, depression, cognitive impairment, reduced quality of life, and frailty on HD patients, and its consequent impact on healthcare delivery will have to be proactively addressed in a multidisciplinary manner,” Dr Prasad told Renal & Urology News. “Understanding how frailty affects health outcomes in hemodialysis patients could assist in the development of management strategies to improve outcomes for this vulnerable patient group. We suggest sequential frailty measurements in hemodialysis units to improve care delivery of patients.”
The medical literature shows that multicomponent exercise training improves physical function, mood and sarcopenia, which are important components of frailty, the investigators noted. “Our study supports the need for similar interventions to be initiated in HD patients as they are high users of emergency rooms and community resources.”
Jafari M, Tondon KK, Prasad B. Frailty in prevalent hemodialysis patients: Regina Frailty Study. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10, 2019 in Washington DC. Poster TH-PO251.