Main Article Content
Abstract
Introduction: The increase in the inclusion of elderly people in hemodialysis programs is connected to a rise in the prevalence of their frailty, considered as well as a prediction of disability and often associated with adverse health events. Given its reversible nature, screening is essential to improve clinical practice.
Objective: To assess the frailty index and the patient functional status in our hemodialysis unit, as well as analyze the differences between diabetics and non-diabetics.
Material and Method: Observational cross-sectional study. Frailty was measured using the Fried phenotype and functional assessment using the Barthel, Lawton, Downton, and Short Physical Performance Battery scales. Comorbidity and fall risk were evaluated with the Charlson and Downton scales, respectively. Diabetic and non-diabetic groups were compared, as well as the relationship between frailty and age, dependency, comorbidity, and fall hazard was analyzed.
Results: A hundred and twenty-eight patients were included in the study. 45% had diabetes. Diabetic patients had a higher average age than non-diabetics (74.2±11 vs 67.8±15 years) and higher comorbidity (Charlson 8.2±2.2 vs 5.8±2.4). Twenty-five percent of the patients had frailty, observing a trend that suggests higher frailty, worse functional capacity, and a higher degree of dependency in diabetic patients, although not significantly.
Conclusions: A quarter of the sampled analyzed presents frailty, with a more pronounced tendency to suffer from it in the case of diabetic patients, which could be related to older age, higher comorbidity, and less functional capacity than non-diabetic people.
Keywords
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Copyright (c) 2023 Sonia Guerrero Carreño, Eva Elías Sanz, Miquel Gomez Umbert, Marta Quintela Martínez, Teresa Gabarró Taulé, Marta Arias Guillen

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References
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- Gorostidi M, Sánchez-Martínez M, Ruilope LM, Graciani A, de la Cruz JJ, Santamaría R, et al. Prevalencia de enfermedad renal crónica en España: impacto de la acumulación de factores de riesgo cardiovascular. Nefrologia 2018;38(6):606-15. DOI: https://doi.org/10.1016/j.nefro.2018.04.004
- Registro español de enfermos renales (REER). Informe 2020 (Datos preliminares). 51 Congreso virtual de la Sociedad Española de Nefrología (SEN) [Internet] 2021 [consultado 11 Sep 2022]. Disponible en: https://www.senefro.org/contents/webstructure/MEMORIA_REER_2020_PRELIMINAR.pdf.
- Beltrán Catalán S, Górriz Teruel J., Pallardó Mateu L. Hemodiálisis en pacientes con diabetes: indicaciones, ventajas y posibles complicaciones. Av en Diabetol 2010;26(4):248-52. DOI: https://doi.org/10.1016/S1134-3230(10)64006-9
- Zingerman B, Korzets A, Ori Y, Herman-Edelstein M, Rozen-Zvi B, Gafter U CA. The very old on hemodialysis: 8 years’ experience in a single unit. Blood Purif 2014;37(1):12-7. DOI: https://doi.org/10.1159/000357016
- Portilla Franco ME, Tornero Molina F, Gil Gregorio P. La fragilidad en el anciano con enfermedad renal crónica. Nefrologia 2016;36(6):609-15. DOI: https://doi.org/10.1016/j.nefro.2016.03.020
- Lee So-Young, Yang DH, Hwang E, Kang SH, Park SH, Kim T, et al. The Prevalence, Association, and Clinical Outcomes of Frailty in Maintenance Dialysis Patients. J Ren Nutr 2017;27(2):106-12. DOI: https://doi.org/10.1053/j.jrn.2016.11.003
- Li Y, Zhang D, Ma Q, Diao Z, Liu S, Shi X. The impact of frailty on prognosis in elderly hemodialysis patients: A prospective cohort study. Clin Interv Aging 2021;16:1659-67. DOI: https://doi.org/10.2147/CIA.S329665
- Tornero F, Portilla ME, Tornero FJ, Herrero JA. Fragilidad y Sarcopenia en la Enfermedad Renal Crónica. Nefrol al día [Internet]. 2020 [consultado 21 Sep 2021]. Disponible en: https://www.nefrologiaaldia.org/es-articulo-fragilidad-sarcopenia-enfermedad-renal-cronica-356.
- Morley JE, Vellas B, Abellan van Kan G, Anker E, Bauer JM, Bernabei R, et al. Frailty Consensus: A Call to Action. J Am Med Dir Assoc 2013;14(6):392-7. DOI: https://doi.org/10.1016/j.jamda.2013.03.022
- Navarrete-Reyes AP, Ávila-Funes JA. Diabetes mellitus y el síndrome de fragilidad en el anciano. Rev Investig Clin [Internet]. 2010 [consultado 27 Abr 2019];62(4):327-32. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21222312.
- Oberg-Higgins BP, McMenamin E, Lee Lucas F, McMonagle E, Morrow J, Ikizler T. et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004;65(3):1009-16. DOI: https://doi.org/10.1111/j.1523-1755.2004.00465.x
- Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol 2014;13(8):823-33. DOI: https://doi.org/10.1016/S1474-4422(14)70026-2
- Reese PP, Cappola AR, Shults J, Townsend RR, Gadegbeku C, Anderson C, et al. Physical performance and frailty in chronic kidney disease. Am J Nephrol 2013;38(4):307-15. DOI: https://doi.org/10.1159/000355568
- López-Soto PJ, De Giorgi A, Senno E, Tiseo R, Ferraresi A, Canella C, et al. Renal disease and accidental falls: A review of published evidence. BMC Nephrol 2015;16(1). DOI: https://doi.org/10.1186/s12882-015-0173-7
- Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: A systematic review. Arch Gerontol Geriatr 2017;68:135-42. DOI: https://doi.org/10.1016/j.archger.2016.10.007
- Lee H-J, Son Y-J. Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021;18(7):3471. DOI: https://doi.org/10.3390/ijerph18073471
- Cook WL, Jassal SV. Functional dependencies among the elderly on hemodialysis. Kidney Int 2008;73(11):1289-95. DOI: https://doi.org/10.1038/ki.2008.62
- Formiga F, Rodríguez Mañas L. Paciente anciano con diabetes mellitus y fragilidad. ¿Asociación siempre presente? Rev Esp Geriatr Gerontol 2014;49(6):253-4. DOI: https://doi.org/10.1016/j.regg.2014.06.006
- Iglesias P, Heras M, Díez JJ. Diabetes mellitus y enfermedad renal en el anciano. Nefrologia 2014;34(3):285-92.
- Fried LP, Tangen CM, Walston J, Newman A, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol Med Sci Am 2001;56(3):146-56. DOI: https://doi.org/10.1093/gerona/56.3.M146
- Johansen K, Delgado C, Bao Y, Kurella Tamura M. Frailty and dialysis initiation. Semin Dial 2013; 26(6):690-6. DOI: https://doi.org/10.1111/sdi.12126
- Bancu I, Graterol F, Bonal J, Fernández-Crespo P, García J, Aguerrevere S, et al. Frail Patient in Hemodialysis: A New Challenge in Nephrology—Incidence in Our Area, Barcelonès Nord and Maresme. J Aging Res 2017;2017:1-5. DOI: https://doi.org/10.1155/2017/7624139
- Abizanda P, López-Torres J, Romero L, López M, Sanchez PM, Atienzar P, et al. Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología. Rev Esp Geriatr Gerontol 2011;46(2):81-8. DOI: https://doi.org/10.1016/j.regg.2010.10.004
- Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of Frailty among Dialysis Patients. J Am Soc Nephrol 2007;18(11):2960-7. DOI: https://doi.org/10.1681/ASN.2007020221
- Walker SR, Wagner M, Tangri N. Chronic Kidney Disease, Frailty, and Unsuccessful Aging: A Review. J Ren Nutr 2014;24(6):364-70. DOI: https://doi.org/10.1053/j.jrn.2014.09.001
- Johansen KL, Dalrymple LS, Delgado C, Chertow GM, Segal MR, Chiang J, et al. Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis. Clin J Am Soc Nephrol 2017;12(7):1100-8. DOI: https://doi.org/10.2215/CJN.12131116
- Kakio Y, Uchida HA, Takeuchi H, Okuyama Y, Okuyama M, Umebayashi R, et al. Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis. Geriatr Gerontol Int. 2018;18(12):1597-602. DOI: https://doi.org/10.1111/ggi.13534
- Arenas MD, Álvarez-Ude F, Angoso M, Berdud I, Antolin A, Lacueva J, et al. Valoración del grado de dependencia funcional de los pacientes en hemodiálisis (HD): Estudio multicéntrico. Nefrologia 2006;26(5):600-8.
- Carvalho TC de, Dini AP. Risk of falls in people with chronic kidney disease and related factors. Rev Lat Am Enfermagem 2020;28:e3289. DOI: https://doi.org/10.1590/1518-8345.3911.3289
- McAdams-DeMarco MA, Suresh S, Law A, Salter ML, Giménez LF, Jaar BG, et al. Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrol 2013;14(1):224. DOI: https://doi.org/10.1186/1471-2369-14-224
- Nogueira Á, Álvarez G, Russo F, San-José B, Sánchez-Tomero JA, Barril G. ¿Es útil el SPPB como método de screening de capacidad funcional en pacientes con enfermedad renal crónica avanzada? Nefrologia 2019;39(5):489-96. DOI: https://doi.org/10.1016/j.nefro.2019.01.003
References
Otero A, de Francisco A, Gayoso P, García F, EPIRCE Study Group. Prevalence of chronic renal disease in Spain: results of the EPIRCE study. Nefrologia 2010;30(1):78-86.
Gorostidi M, Sánchez-Martínez M, Ruilope LM, Graciani A, de la Cruz JJ, Santamaría R, et al. Prevalencia de enfermedad renal crónica en España: impacto de la acumulación de factores de riesgo cardiovascular. Nefrologia 2018;38(6):606-15. DOI: https://doi.org/10.1016/j.nefro.2018.04.004
Registro español de enfermos renales (REER). Informe 2020 (Datos preliminares). 51 Congreso virtual de la Sociedad Española de Nefrología (SEN) [Internet] 2021 [consultado 11 Sep 2022]. Disponible en: https://www.senefro.org/contents/webstructure/MEMORIA_REER_2020_PRELIMINAR.pdf.
Beltrán Catalán S, Górriz Teruel J., Pallardó Mateu L. Hemodiálisis en pacientes con diabetes: indicaciones, ventajas y posibles complicaciones. Av en Diabetol 2010;26(4):248-52. DOI: https://doi.org/10.1016/S1134-3230(10)64006-9
Zingerman B, Korzets A, Ori Y, Herman-Edelstein M, Rozen-Zvi B, Gafter U CA. The very old on hemodialysis: 8 years’ experience in a single unit. Blood Purif 2014;37(1):12-7. DOI: https://doi.org/10.1159/000357016
Portilla Franco ME, Tornero Molina F, Gil Gregorio P. La fragilidad en el anciano con enfermedad renal crónica. Nefrologia 2016;36(6):609-15. DOI: https://doi.org/10.1016/j.nefro.2016.03.020
Lee So-Young, Yang DH, Hwang E, Kang SH, Park SH, Kim T, et al. The Prevalence, Association, and Clinical Outcomes of Frailty in Maintenance Dialysis Patients. J Ren Nutr 2017;27(2):106-12. DOI: https://doi.org/10.1053/j.jrn.2016.11.003
Li Y, Zhang D, Ma Q, Diao Z, Liu S, Shi X. The impact of frailty on prognosis in elderly hemodialysis patients: A prospective cohort study. Clin Interv Aging 2021;16:1659-67. DOI: https://doi.org/10.2147/CIA.S329665
Tornero F, Portilla ME, Tornero FJ, Herrero JA. Fragilidad y Sarcopenia en la Enfermedad Renal Crónica. Nefrol al día [Internet]. 2020 [consultado 21 Sep 2021]. Disponible en: https://www.nefrologiaaldia.org/es-articulo-fragilidad-sarcopenia-enfermedad-renal-cronica-356.
Morley JE, Vellas B, Abellan van Kan G, Anker E, Bauer JM, Bernabei R, et al. Frailty Consensus: A Call to Action. J Am Med Dir Assoc 2013;14(6):392-7. DOI: https://doi.org/10.1016/j.jamda.2013.03.022
Navarrete-Reyes AP, Ávila-Funes JA. Diabetes mellitus y el síndrome de fragilidad en el anciano. Rev Investig Clin [Internet]. 2010 [consultado 27 Abr 2019];62(4):327-32. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21222312.
Oberg-Higgins BP, McMenamin E, Lee Lucas F, McMonagle E, Morrow J, Ikizler T. et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004;65(3):1009-16. DOI: https://doi.org/10.1111/j.1523-1755.2004.00465.x
Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol 2014;13(8):823-33. DOI: https://doi.org/10.1016/S1474-4422(14)70026-2
Reese PP, Cappola AR, Shults J, Townsend RR, Gadegbeku C, Anderson C, et al. Physical performance and frailty in chronic kidney disease. Am J Nephrol 2013;38(4):307-15. DOI: https://doi.org/10.1159/000355568
López-Soto PJ, De Giorgi A, Senno E, Tiseo R, Ferraresi A, Canella C, et al. Renal disease and accidental falls: A review of published evidence. BMC Nephrol 2015;16(1). DOI: https://doi.org/10.1186/s12882-015-0173-7
Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: A systematic review. Arch Gerontol Geriatr 2017;68:135-42. DOI: https://doi.org/10.1016/j.archger.2016.10.007
Lee H-J, Son Y-J. Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021;18(7):3471. DOI: https://doi.org/10.3390/ijerph18073471
Cook WL, Jassal SV. Functional dependencies among the elderly on hemodialysis. Kidney Int 2008;73(11):1289-95. DOI: https://doi.org/10.1038/ki.2008.62
Formiga F, Rodríguez Mañas L. Paciente anciano con diabetes mellitus y fragilidad. ¿Asociación siempre presente? Rev Esp Geriatr Gerontol 2014;49(6):253-4. DOI: https://doi.org/10.1016/j.regg.2014.06.006
Iglesias P, Heras M, Díez JJ. Diabetes mellitus y enfermedad renal en el anciano. Nefrologia 2014;34(3):285-92.
Fried LP, Tangen CM, Walston J, Newman A, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol Med Sci Am 2001;56(3):146-56. DOI: https://doi.org/10.1093/gerona/56.3.M146
Johansen K, Delgado C, Bao Y, Kurella Tamura M. Frailty and dialysis initiation. Semin Dial 2013; 26(6):690-6. DOI: https://doi.org/10.1111/sdi.12126
Bancu I, Graterol F, Bonal J, Fernández-Crespo P, García J, Aguerrevere S, et al. Frail Patient in Hemodialysis: A New Challenge in Nephrology—Incidence in Our Area, Barcelonès Nord and Maresme. J Aging Res 2017;2017:1-5. DOI: https://doi.org/10.1155/2017/7624139
Abizanda P, López-Torres J, Romero L, López M, Sanchez PM, Atienzar P, et al. Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología. Rev Esp Geriatr Gerontol 2011;46(2):81-8. DOI: https://doi.org/10.1016/j.regg.2010.10.004
Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of Frailty among Dialysis Patients. J Am Soc Nephrol 2007;18(11):2960-7. DOI: https://doi.org/10.1681/ASN.2007020221
Walker SR, Wagner M, Tangri N. Chronic Kidney Disease, Frailty, and Unsuccessful Aging: A Review. J Ren Nutr 2014;24(6):364-70. DOI: https://doi.org/10.1053/j.jrn.2014.09.001
Johansen KL, Dalrymple LS, Delgado C, Chertow GM, Segal MR, Chiang J, et al. Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis. Clin J Am Soc Nephrol 2017;12(7):1100-8. DOI: https://doi.org/10.2215/CJN.12131116
Kakio Y, Uchida HA, Takeuchi H, Okuyama Y, Okuyama M, Umebayashi R, et al. Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis. Geriatr Gerontol Int. 2018;18(12):1597-602. DOI: https://doi.org/10.1111/ggi.13534
Arenas MD, Álvarez-Ude F, Angoso M, Berdud I, Antolin A, Lacueva J, et al. Valoración del grado de dependencia funcional de los pacientes en hemodiálisis (HD): Estudio multicéntrico. Nefrologia 2006;26(5):600-8.
Carvalho TC de, Dini AP. Risk of falls in people with chronic kidney disease and related factors. Rev Lat Am Enfermagem 2020;28:e3289. DOI: https://doi.org/10.1590/1518-8345.3911.3289
McAdams-DeMarco MA, Suresh S, Law A, Salter ML, Giménez LF, Jaar BG, et al. Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrol 2013;14(1):224. DOI: https://doi.org/10.1186/1471-2369-14-224
Nogueira Á, Álvarez G, Russo F, San-José B, Sánchez-Tomero JA, Barril G. ¿Es útil el SPPB como método de screening de capacidad funcional en pacientes con enfermedad renal crónica avanzada? Nefrologia 2019;39(5):489-96. DOI: https://doi.org/10.1016/j.nefro.2019.01.003