Risk Factors for Frailty in a Large Prevalent Cohort of Hemodialysis Patients

Abstract

Background Although persons with kidney disease, including those dependent on dialysis, often present clinically with signs and symptoms consistent with frailty, there is limited information about sociodemographic and clinical risk factors that may be associated. Methods 745 patients undergoing hemodialysis (HD) 2009–2011 in 7 Atlanta dialysis clinics and 7 San Francisco Bay Area dialysis clinics were assessed using the validated Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity) that defines frailty as the presence of 3 or more criteria. Study coordinators interviewed participants; measured grip strength, walk speed and body composition; and reviewed records for clinical and laboratory parameters. Logistic regression models were used to estimate the association of patient characteristics with frailty. Results In adjusted analyses, peripheral vascular disease (PVD) and cardiac diseases including dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest were associated with higher odds for frailty, while black race and higher serum albumin concentration were associated with lower odds for frailty. Conclusions In multivariable analyses, HD patients’ risk for frailty, as assessed by the presence of 3 or more criteria that comprise the Fried frailty index, was increased in association with PVD and cardiac conditions such as dysrhythmia and atrial fibrillation, and was decreased for those with higher serum albumin concentration and for blacks compared with whites. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures.

Frail Patient in Hemodialysis: A New Challenge in Nephrology—Incidence in Our Area, Barcelonès Nord and Maresme

“…Frailty among hemodialysis patients is associated with peripheric vasculopathy, cardiac conditions, and low serum albumin [16]. …”

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

“…In this sense, subclinical CVD in older adults was shown to predict frailty and physical and cognitive decline (Chaves et al, 2004) while CVD and hypertension outstood as risk factors for physical and cognitive decline in an older cohort . Similarly, peripheral vascular disease and cardiac diseases were associated with higher odds for frailty in a cohort of hemodialysis patients (Kutner et al, 2014). However, the relationship between CVD and frailty seems to be complex and bidirectional.…”

Pinch grip strength as an alternative assessment to hand grip strength for assessing muscle strength in patients with chronic kidney disease treated by haemodialysis: a prospective audit

“…The present study is the first to compare PS and HGS in patients with chronic kidney disease treated by haemodialysis. HGS is an accepted measure of muscle strength in dialysis patients , as used to assess patient frailty and risk scoring , and has also been reported to be an independent predictor for mortality in dialysis patients . However, to be performed, patients should have HGS measured in the sitting position with the arm held at the side of the body.…”