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Abstract
Background: Frailty is an aging-associated state of increased vulnerability, which raises the risk of adverse outcomes. Chronic kidney disease is associated with higher prevalence of frailty. Our aim was to estimate frailty prevalence in a hemodialysis population and its influence on short-term outcomes.
Design: Observational prospective longitudinal study of 277 prevalent hemodialysis patients. Frailty was estimated through the Edmonton Frail Scale (EFS). Demographic and clinical data, comorbidity index, and laboratory parameters were recorded. A 29-month follow-up was conducted on mortality, including hospitalization, and visits to hospital emergency services in the first 12 months of this period.
Results: According to the EFS, 82 patients (29.6%) were frail, 53 (19.1%) were vulnerable, and 142 (51.3%) were non-frail. During follow-up, 58.5% frail patients, 30.2% vulnerable, and 16.2% non-frail ones died (p < .005). In the analysis of survival using an adjusted Cox model, a higher hazard of mortality was observed in frail than in non-frail patients (HR 2.34; 95% CI 1.39–3.95; p = .001). During follow-up the hospitalization rate was 852 episodes/1000 patient-years for frail patients, 784 episodes/1000 patient-years for vulnerable patients, and 417 episodes/1000 patient-years for non-frail patients (p = .0005). The incidence ratio of visits to emergency services was 3216, 1735, and 1545 visits/1000 patient-years for each group (p < .001).
Conclusions: Hemodialysis patients present high frailty prevalence. Frailty is associated with poor short-term outcomes and higher rates of mortality, visits to hospital emergency services, and hospitalization.
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Details
1 Department of Nephrology, Insular University Hospital of Gran Canaria, Gran Canaria, Spain;; Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Gran Canaria, Spain;
2 Department of Nephrology, Insular University Hospital of Gran Canaria, Gran Canaria, Spain;
3 Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Gran Canaria, Spain;
4 Avericum Dialysis Center, Gran Canaria, Spain;
5 Department of Nephrology, University Hospital of Gran Canaria Dr Negrin, Las Palmas, Spain;
6 Faculty of Mathematics, University of Las Palmas de Gran Canaria, Gran Canaria, Spain