According to a Brazilian consensus, frailty consists of a state of physiological age-related vulnerability that is produced through reduction of homeostatic reserves and reduced capacity of the organism in response to negative health outcomes, such as hospital admissions, falls and functional loss, with increased likelihood of death. 1 Despite being a complex syndrome, frailty can be reversed or mitigated through effective interventions, but for this to occur, it is recommended that screening for frailty should be done early, while patients are still in care. 2 Although the concept of frailty is well established from the physical point of view, it is not an exclusively physical syndrome. It also encompasses biopsychosocial factors that depend on a holistic view of frail individuals. 3,4 The population with chronic kidney disease (CKD) has high incidence and prevalence of physical and cognitive impairment, and is more predisposed to early development of frailty. 5In addition, the process of CKD, from diagnosis to treatment with hemodialysis, leads to several biopsychosocial changes in patients' lives. 6 Mansur, Damasceno and Bastos carried out a study among 146 patients with CKD undergoing conservative treatment (CT), hemodialysis (HD) or peritoneal dialysis (PD), with the aim of assessing the prevalence of frailty and the factors associated with it. 7 They pointed out that frailty occurs frequently among patients with CKD undergoing conservative or dialysis treatment, even among those who are not elderly. In addition, a systematic review by Chowdhury et al. showed that frailty was associated with an increased risk of mortality and hospitalization. 8 In view of this scenario, screening for frailty among patients with CKD is extremely important: not only for elderly individuals but also for younger ones. At early stages of kidney disease, individuals
BACKGROUND: Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle. OBJECTIVE: To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis. DESIGN AND SETTING: Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil. METHODS: This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79). CONCLUSION: Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.Association between frailty and depression among hemodialysis patients: a cross-sectional study | ORIGINAL ARTICLE
Verify the level of loneliness and its relationship with socioeconomic and health conditions, social support, family functionality, and depressive symptoms in patients undergoing hemodialysis. Analysis of secondary data, with a primary cross-sectional investigation, correlational with a quantitative approach, carried out in 2019, with 80 patients with CKD on hemodialysis. Applied instruments: socio-demographic, economic, and health condition characterization, UCLA Loneliness Scale, Medical Outcomes Study Social Support Scale, Patient Health Questionnaire9, and the Family APGAR. Showed female prevalence (55%), white ethnicity (65%), and mean age 59.63 years. In the perception of loneliness, the highest index was (55%), moderately high. Social support scored worst in the Positive Social Interaction domain, mean 74.31. In depression, showed prevalence of severe depression (28.7%). Family functioning showed good score (68.8%). There was a weak negative correlation between loneliness and all domains of Social Support, besides Family Functioning.
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