Hamed Deraz, Amira A Mahmoud, Mohamed Fouad
Background: Frailty has been recognized as a syndrome resulting from cumulative declines in multiple physiologic systems, leading to impaired homeostatic reserve and decreased capacity to withstand stress. Frailty is common in dialysis patients of all ages and is a more sensitive marker of morbidity and mortality than chronological age. Prevention of frailty in hemodialysis patients of all ages could form an active part of nephrology management.
Objective: The aim of the current study was to determine the prevalence and correlates of frailty among hemodialysis patients
Patients and methods: Cross section study was carried out from Oct 2013 to Nov 2014 in the hemodialysis unit of a Zagazig university hospital. The total number of the study was 165 hemodialysis patients, 25 were excluded from the study and thus the final included numbers became 140 hemodialysis patients. All participants were subjected to complete clinical examination. Routine laboratory investigations including corrected serum calcium (Ca) mg/dL, serum phosphate (P) mg/dL and serum intact PTH (i-PTH) (pg/mL) were performed. Anthropometric measurements, including mid arm circumference (MAC), mid-calf circumference (MCC) and body mass index (BMI). Frailty diagnoses and scoring by fried frailty criteria
Results: The prevalence of frailty among hemodialysis patients in Zagazig university hospital was 60%, prefrail 15.7% and non-frail 24.3%. Frailty was started early at mean age of 44.11 ± 6.7 and significantly increase with aging P<0.05. Although gender, smoking, blood pressure, anthropometric measures, diabetes, serum albumin, Ca, P, iPTH, C-reactive protein (CRP), hemoglobin (Hb) % g/dl, RBCs χ106, Platelets χ103,WBCs χ103 and venous access line were assessed for correlation with frailty. Only female gender P<0.001, diabetes P<0.05, hypoalbuminemia P<0.001, severity of secondary hyperparathyroidism P<0.02, inflammatory state P<0.002, anemia P<0.001, and absence of permanent venous access P<0.001 were correlated with frailty. Administration of erythropoietin (EPO) and L.carnitine were negatively correlated with frailty
Conclusion: The prevalence of frailty among hemodialysis patients in this study was an extremely high 60%, approximately 8-9 folds of the general population. Frailty increases with, female gender, diabetics, absence of permanent venous access for hemodialysis, anemia hypoalbuminemia and secondary hyperparathyroidism.