The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition

Abstract

Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD). The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

Frailty and Clinical Outcomes in Patients Treated With Hemodialysis: A Prospective Cohort Study

“…In support of this hypothesis, frailty in incident cases of patients receiving hemodialysis has been associated with a wide range of adverse outcomes, including prolonged postdialysis recovery time, 24 vascular access thrombosis, 25 and perhaps more severe metabolic bone disease. 26 Fifth, previous work suggests that the choice of frailty measure will influence the apparent prevalence of frailty, which should be considered when interpreting our results. 27 For example, using an objective measure of frailty as opposed to self-report tends to lead to a lower prevalence of frailty than reported herein.…”

From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis

“…In chronic haemodialysis patients, frailty score positively correlated with serum CRP and inversely with albumin level. 81 In PD patients, muscle mass, muscle strength and walking speed correlated with serum IL-6, albumin and pre-albumin levels. 82 Taken together, available evidence strongly suggests a correlation between inflammation and frailty, and systemic inflammation probably plays a role in the pathogenesis of frailty.…”

“…The data in the dialysis population are relatively scarce. In chronic haemodialysis patients, frailty score positively correlated with serum CRP and inversely with albumin level 81 . In PD patients, muscle mass, muscle strength and walking speed correlated with serum IL‐6, albumin and pre‐albumin levels 82 .…”