Background and Aims
Frailty is defined as a state of greater vulnerability with less compensatory mechanisms to stressors and is related to worse health outcomes, with the estimated prevalence in the general population> 65 years of approximately 10% and is still higher in population with Chronic Renal Disease (CKD) (26-73%). The Frailty Index based on the Geriatric Integral Assessment (IF-VIG) has been described as a simple tool, fast, with discriminative capacity and predictive (with high correlation with mortality) in geriatric population, but its application in Hemodialysis population has not been reported. We study the frailty in prevalent population in Hemodialysis (HD) applying the IF-VIG, its variables associated and its complications.
Method
observational and prospective, non-interventional study, 361 prevalent patients on hemodialysis in Las Palmas, of the centers of AVERICUM and the Hemodialysis Unit at C.H.U.I.M.I. Demographic and clinical data, related to the technique and dose of dialysis, the Malnutrition-Inflammation Scale (MIS) biochemical parameters and anthropometric parameters were collected.
Results
361 patients, 65% were men, 55% diabetics. Median age: 67 years (57-76), average time in HD o 40 months (20-77). 45% were dialyzed with Central Venous Catheter (CVC) as vascular access (AAVV). The median Charlson Comorbidity Index was 8 (6-9), 242 patients (69% of the population studied) had some degree of malnutrition according to the Malnutrition-Inflammation Scale (MIS), presenting a MIS ≥ 5. A total of 239 patients (66% of the population) were fragile (IF-VIG ≥ 0.20). The clinical variables predictive of frailty were age, sex, comorbidity, the use of CVC as AAVV in HD, the time in the technique and the dialysis dose measured as the average Kt of the last 12 sessions. Table 1. Exitus and hospitalizations were significantly more frequent in the fragile population.
Conclusion
The prevalence of frailty by applying IF-VIG in HD population is very high (66%), including 54% of patients <65 years. The factors associated with frailty in our population were male sex, age, comorbidity, time in the technique, dose of dialysis measured by Kt and the use of CVC as AAVV in HD. Up to 69% of fragile patients are malnourished according to the MIS scale, presenting an MIS ≥5. Exitus and hospitalizations are significantly more frequent in fragile patients. Early identification of fragile patients in HD and the reversible factors associated with this entity would lead to an early multidisciplinary approach, with the aim of reducing the morbidity and mortality of this population.
