The Prevalence and Associated Factors of Frailty Among Hemodialysis Patients
Article Sidebar
Main Article Content
Abstract
Background: Frailty is a multidimensional syndrome of decline that increases the risk of disability, hospitalization, and mortality. Although it is most commonly observed in older adults, chronic kidney disease can precipitate frailty even in younger patients.
Objective: To determine the prevalence of frailty and its associated factors in patients with chronic kidney disease receiving hemodialysis.
Materials and Methods: In this cross-sectional study, patients undergoing hemodialysis at the Lampang Hospital Dialysis Center from June to December 2020 were assessed for frailty using modified Fried frailty phenotype criteria. Participants were classified as frail or non-frail, and factors associated with frailty were identified by logistic regression.
Results: A total of 131 patients were enrolled (38 women, 29.0%), with a mean age of 56.1 ± 11.6 years and a median dialysis vintage of 3.8 [IQR 2.8–4.9] years. Twenty-three patients (17.6%) were frail, 95 (72.5%) were pre-frail, and 13 (9.9%) were robust. The frail group had a higher Charlson Comorbidity Index (CCI) (3.8 ± 1.9 vs. 2.9 ± 1.4; p = 0.01) and lower Karnofsky Performance Status Scale (KPSS) score (70.4 ± 15.5 vs. 86.6 ± 12.6; p < 0.01) than the non-frail group. They also had significantly lower serum hemoglobin (9.2 ± 1.6 vs. 10.2 ± 1.8 g/dL; p = 0.01), serum albumin (3.8 ± 0.4 vs. 4.0 ± 0.4 g/dL; p = 0.02), and serum magnesium (2.1 ±
0.4 vs. 2.4 ± 0.4 mg/dL; p = 0.01). In multivariate analysis, higher CCI (OR 1.47; 95%CI 1.05–2.05; p = 0.03), lower KPSS (OR 0.92; 95% CI 0.89–0.96; p < 0.01), and lower hemoglobin (OR 0.68; 95% CI 0.47–0.99; p = 0.04) were independently associated with frailty.
Conclusion: Frailty and pre-frailty are common among hemodialysis patients. CCI, KPSS, and hemoglobin level are key factors associated with frailty in this population.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
References
Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of frailty among dialysis patients. J Am Soc Nephrol. 2007;18(11):2960–7.
McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, et al. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013;61(6):896–901.
Garcia-Canton C, Rodenas A, Lopez-Aperador C, Rivero Y, Anton G, Monzon T, et al. Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services. Ren Fail. 2019;41(1):567–75.
McAdams-DeMarco MA, Suresh S, Law A, Salter ML, Gimenez LF, Jaar BG, et al. Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study.
BMC Nephrol. 2013;14:224.
Drost D, Kalf A, Vogtlander N, van Munster BC. High prevalence of frailty in end-stage renal disease. Int Urol Nephrol. 2016;48(8):1357–62.
Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: A systematic review. Arch Gerontol Geriatr. 2017;68:135–42.
Lee SY, Yang DH, Hwang E, Kang SH, Park SH, Kim TW, et al. The Prevalence, association, and clinical outcomes of frailty in maintenance dialysis patients. J Ren Nutr. 2017;27(2):106–12.
Takeuchi H, Uchida HA, Kakio Y, Okuyama Y, Okuyama M, Umebayashi R, et al. The prevalence of frailty and its associated factors in Japanese hemodialysis patients. Aging Dis. 2018;9(2):192–207.
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.
van Loon IN, Goto NA, Boereboom FTJ, Bots ML, Verhaar MC, Hamaker ME. Frailty screening tools for elderly patients incident to dialysis. Clin J Am Soc Nephrol. 2017;12(9):1480–8.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Nair D, Liu CK, Raslan R, McAdams-DeMarco M, Hall RK. Frailty in kidney disease: a comprehensive review to advance its clinical and research applications. Am J Kidney Dis. 2025;85(1):89–103.
Fu W, Zhang A, Ma L, Jia L, Chhetri JK, Chan P. Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China. Int J Med Sci. 2021;18(14):3309–17.
Srinonprasert V, Chalermsri C, Aekplakorn W. Frailty index to predict all-cause mortality in Thai community-dwelling older population: A result from a National Health Examination Survey cohort. Arch Gerontol Geriatr. 2018;77:124–8.
ข้อแนะนำเวชปฎิบั ติการฟอกเลือดด้วยเครื่องไตเทียม: สมาคมโรคไตแห่งประเทศไทย; 2022.
Nilmanut S KV, Pekuman P, Tosayanonda O. The Study of The Center for Epidemiologic Studies-Depression Scale (CES-D) in Thai People Siriraj Hospital. J Thai Rehabil 1997;6(3):25-31.
Zhao Y, Liu Q, Ji J. The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. Int Urol Nephrol. 2020;52(1):115–20.
Taylor HL, Jacobs DR, Jr., Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31(12):741–55.
Chan GC, Kalantar-Zadeh K, Ng JK, Tian N, Burns A, Chow KM, et al. Frailty in patients on dialysis. Kidney Int. 2024;106(1):35–49.
Eriksson D, Goldsmith D, Teitsson S, Jackson J, van Nooten F. Cross-sectional survey in CKD patients across Europe describing the association between quality of life and anaemia. BMC Nephrol. 2016;17(1):97.
21. Smith G, Avenell A, Band MM, Hampson G, Lamb EJ, Littleford RC, et al. Associations between frailty, physical performance, and renal biomarkers in older people with advanced chronic kidney disease. Eur Geriatr Med. 2021;12(5):943–52.
Young EW, Wang D, Kapke A, Pearson J, Turenne M, Robinson BM, et al. Hemoglobin and clinical outcomes in hemodialysis: an analysis of US medicare data From 2018 to 2020. Kidney Med. 2023;5(2):100578.
Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol. 2013;24(3):337–51.
Amparo FC, Cordeiro AC, Carrero JJ, Cuppari L, Lindholm B, Amodeo C, et al. Malnutrition-inflammation score is associated with handgrip strength in nondialysisdependent chronic kidney disease patients. J Ren Nutr. 2013;23(4):283–7.
Hori M, Yasuda K, Takahashi H, Morozumi K, Maruyama S. The association of low serum magnesium levels with frailty among hemodialysis patients. Sci Rep. 2023;13(1):14982.
Murthy L, Dreyer P, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, et al. Association between high levels of parathyroid hormone and frailty: The Nepean Osteoporosis and Frailty (NOF) Study. J Frailty Aging. 2018;7(4):253–7.
Moreno LD, Ruiz CE, Urrego JC, Cadena MO, Maldonado SJ, Nino DA, et al. Frailty syndrome and end-stage kidney disease outcomes at a Latin American dialysis center. Biomedica. 2023;43(Sp.3):21–9.
Kidney Disease: Improving Global Outcomes CKDMBDUWG. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKDMBD). Kidney Int Suppl (2011). 2017;7(1):1–59.
