Association between social frailty as well as early physical dysfunction and exercise intolerance among older patients receiving hemodialysis

Abstract

Background Recently, social frailty has been increasingly recognized as a factor associated with adverse health outcomes, including physical disability and mortality. However, there are no studies about the importance of this factor among hemodialysis patients. Therefore, we investigated the relationship between social frailty and early physical dysfunction in this group of patients. Methods This was a two‐center cross‐sectional study. Older patients receiving hemodialysis were prospectively enrolled. Moreover, participants were evaluated for social frailty based on the definition of previous study and for physical function, peak oxygen uptake (peak VO2), ventilatory equivalent for carbon dioxide (VE/VCO2) slope and heart rate reserve. Then, they were divided into two groups based on the presence of physical frailty. Results Data collected from 158 individuals were statistically analyzed. The prevalence rate of social frailty was 59.5%. In the non‐physical frailty group, social frailty was found to be independently associated with reduced gait speed (P = 0.007), leg strength (P = 0.040) and peak VO2 (P = 0.023), but not with hand grip strength (P = 0.36). In the physical frailty group, there was no association between social frailty and physical function. Moreover, in patients without physical and social frailty, physical function was maintained at above accepted threshold levels, whereas peak VO2 (14.1 ± 3.3 mL/kg/min), VE/VCO2 slope (32.3 ± 5.5) and heart rate reserve (50.8% ± 21.7%) were substantially impaired. Conclusions Patients receiving hemodialysis can present with social frailty and exercise intolerance with cardiac dysfunction in the early phase, which may contribute to subsequent dysfunction. Geriatr Gerontol Int 2021; 21: 664–669.

Relationships between frailty and exercise capacity in patients undergoing hemodialysis: A cross‐sectional study

“…This study investigated the associations of frailty phenotypes and the number of frailty components with exercise capacity. Our previous study reported that frailty was associated with a lower peakVO 2 than non‐frailty, including the phenotypes robust and pre‐frail, 26 while HD patients with frailty in the present study showed a significant decrease of peakVO 2 compared with patients with pre‐frail and robust phenotypes. In addition, peakVO 2 had a declining trend with an increased number of frailty components, and the frailty phenotype and number of frailty components were associated with peakVO 2 .…”

“…However, physical function is not the sole factor related to exercise capacity and frail. Our previous study in HD patients without frailty reported that patients with social frailty had lower peakVO 2 and physical function compared with those without social frailty 26 . In addition, social isolation of the older population has been reported to be associated with the progression of frailty 34 .…”

“…Our previous study in HD patients without frailty reported that patients with social frailty had lower peakVO 2 and physical function compared with those without social frailty. 26 In addition, social isolation of the older population has been reported to be associated with the progression of frailty. 34 Furthermore, patients undergoing HD often have an imbalance of muscle protein synthesis and degradation 35 and protein-energy wasting.…”

Correlation between acylcarnitine/free carnitine ratio and cardiopulmonary exercise test parameters in patients with incident dialysis

“…Heart rate (HR) was continuously monitored and blood pressure was measured every minute during CPX. Peak work rate (WR) and peak HR were recorded during CPX, and chronotropic index (%) was evaluated using the following equation: chronotropic index (%) = (peak HR − rest HR)/(220 − age − rest HR) × 100 ( Usui et al, 2021 ).…”

Supporting Factors in Continuing Life of Chronic Renal Failure Patients Undergoing Hemodialysis

“…It is also emphasized by advising health care providers, family members, and mental health providers on the purpose of social support for this group of patients. Research conducted by Usui N et al (15) showed patients who received dialysis treatment may involve social weakness.…”