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Volumen 25 nº 1 2022
Submitted
November 20, 2021
Published
March 30, 2022
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Abstract

Introduction: The age of patients on hemodialysis is increasing, presenting greater deterioration.


Objectives: To know the situation of the elderly patient on hemodialysis, categorizing our population. Analyze the relationship between the scales of functionality, malnutrition and comorbidity.


Method: Cross-sectional descriptive study, patients 75-95 years old. Were measured: a) Comorbidity-CHARLSON: high (>6 points). b) Nutrition-MISS: extremely malnourished (<10 points); very severe malnutrition (>7-10 points); moderate-severe (>5-7 points.); mild-moderate (>2-5 points); normonourished (<2 points.); c) Dependence-BARTHEL, independent (100 points.); dependency level (91-99 points.); moderate (61-90 points); severe (21-60 points); totals (<20 points). d) Frailty-FRAIL, without frailty (0 points); prefragile (1-2 points); fragile (>3 points).


Results: 60 patients, 68%(41) men, mean age 81.85±5.58 years and HD time 49.88±40.29 months. Most prevalent etiology, diabetes mellitus (28%). MIS: 6.01±3.80 points. classifying 8(13%) as normonourished, 24(40%) as mild-moderate malnutrition, 10(17%) as moderate-severe malnutrition, 13(22%) as very severe malnutrition, and 5 (8%) as extremely malnourished. BARTHEL:88.16±18.59 points, classified 32(53%) independent, 6(10%) mild dependence, 17(28%) moderate dependence, 4(7%) severe dependence, 1(2%) dependence total. FRAGILE:1.98±1.32 points, classified 10(17%) non-frail, 31(51%) pre-frail and 19(32%) frail. CHARLSON:10.01±2.20 points. Presenting 60(100%) high comorbidity. CHARLSON presented differences between sex, higher in men (p=0.002). High coincidence was found between Barthel and Frail (r=0.647, p<0.001), moderate between MIS and Barthel (r=0.556, p<0.001) and MIS and Frail (r=0.455, p<0.001). Charlson was the scale with the worst correlation.


Conclusions: The results showed a great general deteriora­tion of elderly patients on dialysis, highlighting the need for individualised treatments focused on their recovery, inclu­ding the dialysis technique itself.

Keywords

haemodialysis elderly malnutrition dependency frailty comorbidity

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Sánchez-Tocino ML, Miranda-Serrano B, Villoria-González S, Pereira-García M, López-González A, González-Parra E. Functional classification of the elderly haemodialysis patient and its influence on individualisation of treatment. Enferm Nefrol [Internet]. 2022 [cited 2025 Apr 30];25(1):[about 10 p.]. Available from: https://www.enfermerianefrologica.com/revista/article/view/4438
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References

  1. Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016 6;11(7): e0158765. DOI: https://doi.org/10.1371/journal.pone.0158765
  2. Jager KJ, Lindholm B, Goldsmith D, for European Renal and Cardiovascular Medicine working group of the European Renal Association–European Dialysis and Transplant Association (ERA–EDTA). Cardiovascular and non-cardiovascular mortality indialysis patients: Where is the link? Kidney Int Supl 2011;1(1):S21–3.
  3. Tazza L, Di Napoli A, Bossola M, Valle S, Pezzotti P, Luciani G, et al. Ageing of patients on chronic dialysis: Effects on mortality: A 12-year study. Nephrol Dial Transplant. 2009;24(3):940–7. DOI: https://doi.org/10.1093/ndt/gfn575
  4. Fried LF, Lee JS, Shlipak M, Chertow GM, Green C, Ding J, et al. Chronic Kidney Disease and Functional Limitation in Older People: Health, Aging and Body Composition Study. J Am Geriatr Soc. 2006; 54:750–6. DOI: https://doi.org/10.1111/j.1532-5415.2006.00727.x
  5. Sánchez-Tocino ML, Miranda-Serrano B, Gracia-Iguacel C, de-Alba-Peñaranda AM, Mas-Fontao S, López-González A, et al. Sarcopenia assessed by 4-step EWGSOP2 in elderly hemodialysis patients: Feasibility and limitations. PLoS One. 2022;17(1): e0261459. DOI: https://doi.org/10.1371/journal.pone.0261459
  6. Bowling CB, Sawyer P, Campbell RC, Ahmed A, Allman RM. Impact of chronic kidney disease on activities of daily living in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2011;66:689-94. DOI: https://doi.org/10.1093/gerona/glr043
  7. Sánchez-Tocino ML, González-Parra E, Miranda-Serrano B, Gracia-Iguacel C, de-Alba-Peñaranda AM, López-González A, et al. Evaluation of the impact of an intradialytic exercise program on sarcopenia in very elderly hemodialysis patients, Clinical Kidney Journal. [Internet]. 2022; [consultado 15 Ene 2022]; sfac046. Disponible en: https://doi.org/10.1093/ckj/sfac046. DOI: https://doi.org/10.1093/ckj/sfac046
  8. Moure L, Puialto MJ, Antolín R. Cambios nutricionales en el proceso de envejecimiento. Enfermería global. 2003;2:1-16.
  9. Ikizler TA, Flakoll PJ, Parker RA, Hakim RM. Amino acid and albumin losses during hemodialysis. Kidney Int 1994;46:830–7.
  10. Jassal SV, Karaboyas A, Comment LA, Bieber BA, Morgenstern H, Sen A, et al. Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS) Am J Kidney Dis. 2016;67:283–92. DOI: https://doi.org/10.1053/j.ajkd.2015.09.024
  11. Jassal SV, Chiu E, Hladunewich M. Loss of independence in patients starting dialysis at 80 years of age or older. New Engl J Med. 2009;361:1612–3. DOI: https://doi.org/10.1056/NEJMc0905289
  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J ChronicDis. 1987;40:373–83. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
  13. Hernández A, Pontes Y, Goñi I. Riesgo de malnutrición en una población mayor de 75 años no institucionalizada con autonomía funcional. Nutr. Hosp. [Internet]. 2015 [consultado 7 Oct 2021]; 32(3):1184-92. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112015000900030&lng=es.
  14. Rubio MA, Lou LM, Gimeno JA, Munguia P, Gutiérrez A, Lamban E, et al. Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador. Nefrología. 2019;39(2):141-50. DOI: https://doi.org/10.1016/j.nefro.2018.07.009
  15. Gracia O, Lou L.M, Abad J.M, Álvarez R, Pérez J, García M, et al. Mortalidad durante el primer año y cumplimiento de los estándares de calidad de los pacientes incidentes en tratamiento renal sustitutivo en Aragón. Diálisis y Trasplante. 2017;38(1):57-63.
  16. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH: A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001;38(6):1251-63. DOI: https://doi.org/10.1053/ajkd.2001.29222
  17. Wollinski FD, Callahan CM, Fitzgerald JF, Johnson RJ. Changes in functional status and the risks of subsequent nursing home placement and death. J Gerontol. 1993; 48(Supl 3):S94-101.
  18. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J ClinEpidemiol. 1989;42:703–9. DOI: https://doi.org/10.1016/0895-4356(89)90065-6
  19. Morley JE, Vellas B, Van Kan GA, Anker DS, Bauer JM, Bernabei R, el al. Frailty consesus: a call to action. J Am Mad Dir Assosc. 2013;14(6):392-7. DOI: https://doi.org/10.1016/j.jamda.2013.03.022
  20. González E. Composición Corporal; valoración y valor clínico. Endocrino Nutr. 2013;60(2):69-75. DOI: https://doi.org/10.1016/j.endonu.2012.04.003
  21. Pérez-García R, Jaldo M, Alcázar R, de Sequera P, Albalate M, Puerta M, et al. El Kt/V alto, a diferencia del Kt, se asocia a mayor mortalidad: importancia de la V baja. Nefrología. 2019;39(1):58-66. DOI: https://doi.org/10.1016/j.nefro.2018.04.006
  22. Kurella M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009; 361(16):1539-47. DOI: https://doi.org/10.1056/NEJMoa0904655
  23. Ikizler TA, Pupim LB, Brouillette JR, Levenhagen DK, Farmer K, Hakim RM, et al. Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab. 2002; 282: E107. DOI: https://doi.org/10.1152/ajpendo.2002.282.1.E107
  24. Ikizler TA, Flakoll PJ, Parker RA, Hakim RM. Amino acid and albumin losses during hemodialysis. Kidney Int. 1994;46(3):830-7. DOI: https://doi.org/10.1038/ki.1994.339
  25. Gelder BM, Tijhuis MA, Kalmijn S, Giampaoli S, Nissinen A, Kromhout D. Physical activity in relation to cognitive decline in elderly men: the FINE study. Neurology. 2004; 63(12):2316-21. DOI: https://doi.org/10.1212/01.WNL.0000147474.29994.35
  26. Saka B, Kaya O, Ozturk GB, Erten N, Karan MA. Malnutrition in the elderly and its relationship with other geriatric síndromes. Clin Nutr. 2010;29(6):745-8. DOI: https://doi.org/10.1016/j.clnu.2010.04.006
  27. Lowrie EG, Lew NL. Commonly measured laboratory variables in hemodialysis patients: relationships among them and to death risk. Semin Nephrol. 1992; 12(3):276-83.
  28. García-Cantón C, Ródenas A, López C, Rivero Y, Díaz N, Antón G, et al. Frailty prevalence and associated factors in hemodialysis patients. Nefrologia (Engl Ed). 2019; 39(2):204-6. DOI: https://doi.org/10.1016/j.nefroe.2018.07.011
  29. Kang SH, Do JY, Lee SY, Kim JC. Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients. PLoS One. 2017; 12(5): e0176814. DOI: https://doi.org/10.1371/journal.pone.0176814
  30. Rubio M, San Juan A, Gutierrez A, Mercadal E, Blasco A, Navarro PM, et al. Fragilidad en pacientes con Enfermedad renal crónica avanzada en tratamiento renal conservador. Diálisis y Trasplante. 2017;38:92-9.
  31. Ollero M, Cabrera JM, de Osorno M, de Villar E, García D, Gómez E, et al. Atención al paciente pluripatológico: Proceso asistencial integrado. Sevilla: Consejería de Salud; 2007 (3ª edición).
  32. Thong MS, Kaptein AA, Krediet RT, Boeschoten EW, Dekker FW. Social support predicts survival in dialysis patients. Nephrol Dial Transplant. 2007;22(3):845-50. DOI: https://doi.org/10.1093/ndt/gfl700
  33. Lin YT, Wu PH, Kuo MC, Lin MY, Lee TC, Chiu YW, et al. High cost and low survival rate in high comorbidity incident elderly hemodialysis patients. PLoS One. 2013; 8(9): e75318. DOI: https://doi.org/10.1371/journal.pone.0075318
  34. Sclauzero P, Galli G, Barbati G, Carraro M, Panzetta GO. Role of components of frailty on quality of life in dialysis patients: a cross-sectional study. J Ren Care. 2013;39(2):96-102. DOI: https://doi.org/10.1111/j.1755-6686.2013.12013.x
  35. Torres B, Núñez E, de Guzmán D, Simón JP, Alastuey C, Melián JD, et al. Índice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia. Revista Española de Geriatría y Gerontología. 2009; 44(4):209-12. DOI: https://doi.org/10.1016/j.regg.2009.02.002

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