The Prevalence of Frailty and its Associated Factors in Japanese Hemodialysis Patients

Abstract

The population undergoing dialysis is aging worldwide, particularly in Japan. The clinical condition of frailty is the most problematic expression in the elderly population. Potential pathophysiological factors of frailty present in patients with CKD and are accentuated in patients with ESRD. The aim of this study was to identify the prevalence and predictors of frailty in Japanese HD patients. This study was a multicenter, cross-sectional and observational investigation conducted at 6 institutions. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese as the self-reported questionnaire was used. Of the 542 patients visiting each institution, 388 were enrolled in this study. In total, 26.0% of participants were categorized as not-frailty, 52.6% as pre-frailty and 21.4% as frailty. The prevalence of frailty increased steadily with age and was more prevalent in females than in males and the subjects with frailty received polypharmacy. A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: female gender (odds ratio [OR] = 3.661, 95% confidence interval [CI] 1.398-9.588), age (OR = 1.065, 95% CI 1.014-1.119), age ≥ 75 years old (OR = 4.892, 95% CI 1.715-13.955), body mass index (BMI) < 18.5 (OR = 0.110, 95% CI 0.0293-0.416), number of medications being taken (OR = 1.351, 95% CI 1.163-1.570), diabetes mellitus (DM) (OR = 2.765, 95% CI 1.081-7.071) and MNA-SF ≤ 11 (OR = 7.405, 95% CI 2.732-20.072). Frailty was associated with the accumulation of risk factors. The prevalence of frailty in Japanese patients with HD was relatively lower than that previously reported in Western developed countries; however, it was extremely high compared to the general population regardless of age. Our findings suggest that frailty might be associated with an increase in the prevalence of adverse health outcomes in patients with HD.

Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis

“…Therefore, the patients were more health conscious than other patients who were not included in this study. Third, as the authors noted in our original study, frailty was not evaluated objectively, because the diagnosis of frailty was partially based on subjective evaluation . It is necessary to examine the reliability and validity of our criteria.…”

“…The initial exclusion criteria were: (i) patients who refused to participate; (ii) patients who were in a hospital due to accidents or sickness; and (iii) patients who were unable to answer the questionnaire. In addition, the authors excluded participants who did not completely fill in the frailty information, as the authors described previously …”

“…By checking medical records, the following risk factors of each participant were evaluated: body mass index, hypertension, dyslipidemia, history of smoking, ischemic heart disease (IHD), stroke (STK), spinal compression fracture, history of falling, frequency and quantity of HD, data of blood tests, and ankle‐brachial index (ABI) . The definition of hypertension, dyslipidemia, IHD, STK, spinal compression fracture, history of falling and measurement of physical domain were described previously . To evaluate the HD efficiency, single‐pooled Kt/V was calculated .…”

“…The operational definition of the frailty phenotype in the present study was previously described elsewhere . Individuals who met at least three criteria of all five criteria were defined as “frail,” and individuals who met one or two criteria were defined as “pre‐frail.” Those who did not meet any criteria were considered as “normal.” All five criteria were modified from the original Fried Cardiovascular Health Study (CHS) frailty phenotype …”

“…Kurella Tamura et al reported that 39% of nursing home residents (mean age 73.4 ± 10.9 years) maintained their physiological function 3 months after the initiation of dialysis in the USA . Previously, the authors reported that the prevalence of frailty in Japanese patients with HD was relatively lower than that in Western developed countries; however, it was extremely high compared with the general population, regardless of age . Thus, a close relationship has been suggested among frailty, aging and dialysis.…”