Barra lateral de artículos
Descargas
Contenido del artículo principal
Resumen
Introducción: La fragilidad es un síndrome caracterizado por la disminución de la reserva fisiológica y mayor vulnerabilidad a complicaciones, caídas y mortalidad. En España, la población anciana en hemodiálisis está en aumento, con prevalencias de fragilidad del 26-73% según el instrumento de medida.
Objetivo: El objetivo fue evaluar la prevalencia de fragilidad en pacientes incidentes en hemodiálisis mediante la escala FRAIL.
Material y Método: Estudio descriptivo prospectivo realizado entre noviembre de 2024 y marzo de 2025, con muestreo incidental. Se incluyeron 51 pacientes incidentes en hemodiá-lisis. Se recogieron datos demográficos, etiología de la enfermedad renal, diabetes mellitus y acceso vascular. La fragilidad se evaluó con la escala FRAIL (cinco ítems: fatigabilidad, resistencia, deambulación, comorbilidad y pérdida de peso), clasificando a los pacientes como frágiles (>3 puntos), prefrágiles (1-2) o no frágiles (0).
Resultados: Edad media: 68,76±12,18 años; 74,5% hombres. La etiología más frecuente fue no filiada (25%). El 64,7% fueron frágiles, el 29,7%, prefrágiles, y el 5,9%, no frágiles. Las alteraciones más frecuentes fueron problemas de resistencia (76,5%), fatigabilidad (64,7%) y pérdida de peso (58,8%). La diabetes mellitus se asoció significativamente con fragilidad (p=0,012). No se hallaron diferencias con edad, género, índice de masa corporal, procedencia, acceso vascular o inicio urgente.
Conclusiones: La prevalencia combinada de fragilidad y prefragilidad alcanzó el 94,4%. La escala FRAIL demostró ser un instrumento rápido y útil para la detección precoz, lo que facilita la implementación de intervenciones preventivas. Se precisan estudios multicéntricos y con mayor tamaño muestral para confirmar estos resultados.
Palabras clave
Detalles del artículo
Derechos de autor 2025 Francisco Cirera-Segura, María del Rocío Manzano-Angua, María Adelaida Martín-Carrasco
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Aviso de derechos de autor/a
© Los autores ceden de forma no exclusiva los derechos de explotación de los trabajos publicados y consiente en que su uso y distribución se realice con la Licencia Creative Commons Atribución - No comercial 4.0 Internacional (CC BY-NC 4.0). Puede consultar desde aquí la versión informativa y el texto legal de la licencia. Esta circunstancia ha de hacerse constar expresamente de esta forma cuando sea necesario.
Referencias
- Kojima G, Liljas A, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy. 2019;12:23-30. DOI: https://doi.org/10.2147/RMHP.S168750
- Oki R, Hamasaki Y, Tsuji S, Suzuki K, Tsuneishi S, Imafuku M, et al. Clinical frailty assessment might be associated with mortality in incident dialysis patients. Sci Rep. 2022;12(1):17651. DOI: https://doi.org/10.1038/s41598-022-22483-8
- Sy J, Johansen KL. The impact of frailty on outcomes in dialysis: Curr Opin Nephrol Hypertens. 2017;26(6):537-42. DOI: https://doi.org/10.1097/MNH.0000000000000364
- Alfaadhel TA, Soroka SD, Kiberd BA, Landry D, Moorhouse P, Tennankore KK. Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol CJASN. 2015;10(5):832-40. DOI: https://doi.org/10.2215/CJN.07760814
- Barbosa EMS, Pereira AG, Mori V, da Silva Neves R, Vieira NM, Silva MZC, et al. Comparison between FRAIL scale and clinical frailty scale in predicting hospitalization in hemodialysis patients. J Nephrol. 2023;36(3):687-93. DOI: https://doi.org/10.1007/s40620-022-01532-5
- Chiu-Hui Chen, Yu-Ling Hsieh, Shao-Yuan Chuang, Fan-Yin Su, Kuan-Ting Wang, Chien-Ming Luo, et al. The impact of frailty on the outcomes of hemodialysis vascular access. Acta Cardiol Sin. 2022;38(1).
- Mei F, Gao Q, Chen F, Zhao L, Shang Y, Hu K, et al. Frailty as a predictor of negative health outcomes in chronic kidney disease: a systematic review and meta-analysis. J Am Med Dir Assoc. 2021;22(3):535-543.e7. DOI: https://doi.org/10.1016/j.jamda.2020.09.033
- McAdams–DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, et al. Frailty as a Novel Predictor of Mortality and Hospitalization in Individuals of All Ages Undergoing Hemodialysis. J Am Geriatr Soc. 2013;61(6):896-901. DOI: https://doi.org/10.1111/jgs.12266
- Zhang Q, Ma Y, Lin F, Zhao J, Xiong J. Frailty and mortality among patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol. 2020;52(2):363-70. DOI: https://doi.org/10.1007/s11255-019-02369-x
- Goto NA, Van Loon IN, Boereboom FTJ, Emmelot-Vonk MH, Willems HC, Bots ML, et al. Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. Clin J Am Soc Nephrol. 2019;14(7):1039-47. DOI: https://doi.org/10.2215/CJN.13131118
- Godin J, Armstrong JJ, Wallace L, Rockwood K, Andrew MK. The impact of frailty and cognitive impairment on quality of life: employment and social context matter. Int Psychogeriatr. 2019;31(6):789-97. DOI: https://doi.org/10.1017/S1041610218001710
- Registro Español de Enfermos Renales (REER) Informe 2021 (datos preliminares). Sociedad Española de Nefrología [Internet]. 2022 [consultado 31 May 2023]; Disponible en: https://www.senefro.org/contents/webstructure/MEMORIA_REER_2021_PRELIMINAR.pdf
- García-Cantón C, Ródenas-Gálvez A, López-Aperador C, Rivero Y, Díaz N, Antón G, et al. Prevalencia de fragilidad y factores asociados en pacientes en programa de hemodiálisis. Nefrología [Internet]. 2019 [consultado 19 de febrero de 2025];39(2):204-6. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0211699518301498 DOI: https://doi.org/10.1016/j.nefro.2018.07.012
- Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, et al. Association between Body Composition and Frailty among Prevalent Hemodialysis Patients: A US Renal Data System Special Study. J Am Soc Nephrol. 2014;25(2):381-9. DOI: https://doi.org/10.1681/ASN.2013040431
- Ozturk S, Cetin DG, Cetin M, Yilmaz MD, Ozler TE, Cebeci E, et al. Prevalence and associates of frailty status in different stages of chronic kidney disease: a cross-sectional study. J Nutr Health Aging. 2022;26(9):889-95. DOI: https://doi.org/10.1007/s12603-022-1839-z
- Johansen KL, Dalrymple LS, Glidden D, Delgado C, Kaysen GA, Grimes B, et al. Association of Performance-Based and Self–Reported Function–Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis. Clin J Am Soc Nephrol. 2016;11(4):626-32. DOI: https://doi.org/10.2215/CJN.03710415
- Zhao Y, Liu Q, Ji J. The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. Int Urol Nephrol. 2020;52(1):115-20. DOI: https://doi.org/10.1007/s11255-019-02310-2
- Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8. DOI: https://doi.org/10.1007/s12603-012-0084-2
- Arias-Rivera S, Sánchez-Sánchez MM, Jareño-Collado R, Raurell-Torredà M, Oteiza-López L, López-Cuenca S, et al. Fiabilidad intraobservador e interobservador de las escalas de fragilidad Clinical Frailty Scale-España y FRAIL-España en pacientes críticos. Med Intensiva. 2025;502131. DOI: https://doi.org/10.1016/j.medin.2024.502131
- Fierro-Marrero J, Reina-Varona Á, Pardo-Montero J, Paris-Alemany A, La Touche R. Adaptation, development, validity, and reliability of the Escala Multidimensional de Fragilidad (EMFRA), and the 5-item FRAIL scale: a study design of the EMFRA project. J MOVE Ther Sci. 2024;6(1):639-52. DOI: https://doi.org/10.37382/jomts.v6i1.1158
- Moreno LD, Ruiz CE, Urrego JC, Cadena MO, Maldonado SJ, Niño DA, et al. Frailty syndrome and end-stage kidney disease outcomes at a Latin American dialysis center. Biomédica. 2023;43(Sp. 3):S21-9. DOI: https://doi.org/10.7705/biomedica.7057
- Moreno-Useche LD, Urrego-Rubio J, Cadena-Sanabria M, Rodríguez Amaya R, Maldonado-Navas S, Ruiz-González C. Frailty syndrome in patients with chronic kidney disease at a dialysis centre from santander, colombia. J Gerontol Geriatr. 2021;69(2):103-9. DOI: https://doi.org/10.36150/2499-6564-N249
- Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3-10. DOI: https://doi.org/10.1016/j.ejim.2016.03.007
- Johansen K, Chertow G, Jin C, Kutner N. Significance of frailty among dialysis patients. J Am Soc Nephrol JASN. 2007. DOI: https://doi.org/10.1681/ASN.2007020221
- Painter P, Kuskowski M. A closer look at frailty in ESRD: getting the measure right. Hemodial Int Int Symp Home Hemodial. 2013;17(1):41-9. DOI: https://doi.org/10.1111/j.1542-4758.2012.00719.x
- Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.a task force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29-37. DOI: https://doi.org/10.1007/BF02982161
- López D, Flicker L, Dobson A. Validation of the frail scale in a cohort of older australian women. J Am Geriatr Soc. 2012;60(1):171-3. DOI: https://doi.org/10.1111/j.1532-5415.2011.03746.x
- Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc. 2017;18(12):1082-6. DOI: https://doi.org/10.1016/j.jamda.2017.07.005
- Chao CT, Chiang CK, Huang JW, Hung KY, COGENT study group. Self-reported frailty among end-stage renal disease patients: a potential predictor of dialysis access outcomes. Nephrol Carlton Vic. 2017;22(4):333-4. DOI: https://doi.org/10.1111/nep.12961
Referencias
Kojima G, Liljas A, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy. 2019;12:23-30. DOI: https://doi.org/10.2147/RMHP.S168750
Oki R, Hamasaki Y, Tsuji S, Suzuki K, Tsuneishi S, Imafuku M, et al. Clinical frailty assessment might be associated with mortality in incident dialysis patients. Sci Rep. 2022;12(1):17651. DOI: https://doi.org/10.1038/s41598-022-22483-8
Sy J, Johansen KL. The impact of frailty on outcomes in dialysis: Curr Opin Nephrol Hypertens. 2017;26(6):537-42. DOI: https://doi.org/10.1097/MNH.0000000000000364
Alfaadhel TA, Soroka SD, Kiberd BA, Landry D, Moorhouse P, Tennankore KK. Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol CJASN. 2015;10(5):832-40. DOI: https://doi.org/10.2215/CJN.07760814
Barbosa EMS, Pereira AG, Mori V, da Silva Neves R, Vieira NM, Silva MZC, et al. Comparison between FRAIL scale and clinical frailty scale in predicting hospitalization in hemodialysis patients. J Nephrol. 2023;36(3):687-93. DOI: https://doi.org/10.1007/s40620-022-01532-5
Chiu-Hui Chen, Yu-Ling Hsieh, Shao-Yuan Chuang, Fan-Yin Su, Kuan-Ting Wang, Chien-Ming Luo, et al. The impact of frailty on the outcomes of hemodialysis vascular access. Acta Cardiol Sin. 2022;38(1).
Mei F, Gao Q, Chen F, Zhao L, Shang Y, Hu K, et al. Frailty as a predictor of negative health outcomes in chronic kidney disease: a systematic review and meta-analysis. J Am Med Dir Assoc. 2021;22(3):535-543.e7. DOI: https://doi.org/10.1016/j.jamda.2020.09.033
McAdams–DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, et al. Frailty as a Novel Predictor of Mortality and Hospitalization in Individuals of All Ages Undergoing Hemodialysis. J Am Geriatr Soc. 2013;61(6):896-901. DOI: https://doi.org/10.1111/jgs.12266
Zhang Q, Ma Y, Lin F, Zhao J, Xiong J. Frailty and mortality among patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol. 2020;52(2):363-70. DOI: https://doi.org/10.1007/s11255-019-02369-x
Goto NA, Van Loon IN, Boereboom FTJ, Emmelot-Vonk MH, Willems HC, Bots ML, et al. Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. Clin J Am Soc Nephrol. 2019;14(7):1039-47. DOI: https://doi.org/10.2215/CJN.13131118
Godin J, Armstrong JJ, Wallace L, Rockwood K, Andrew MK. The impact of frailty and cognitive impairment on quality of life: employment and social context matter. Int Psychogeriatr. 2019;31(6):789-97. DOI: https://doi.org/10.1017/S1041610218001710
Registro Español de Enfermos Renales (REER) Informe 2021 (datos preliminares). Sociedad Española de Nefrología [Internet]. 2022 [consultado 31 May 2023]; Disponible en: https://www.senefro.org/contents/webstructure/MEMORIA_REER_2021_PRELIMINAR.pdf
García-Cantón C, Ródenas-Gálvez A, López-Aperador C, Rivero Y, Díaz N, Antón G, et al. Prevalencia de fragilidad y factores asociados en pacientes en programa de hemodiálisis. Nefrología [Internet]. 2019 [consultado 19 de febrero de 2025];39(2):204-6. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0211699518301498 DOI: https://doi.org/10.1016/j.nefro.2018.07.012
Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, et al. Association between Body Composition and Frailty among Prevalent Hemodialysis Patients: A US Renal Data System Special Study. J Am Soc Nephrol. 2014;25(2):381-9. DOI: https://doi.org/10.1681/ASN.2013040431
Ozturk S, Cetin DG, Cetin M, Yilmaz MD, Ozler TE, Cebeci E, et al. Prevalence and associates of frailty status in different stages of chronic kidney disease: a cross-sectional study. J Nutr Health Aging. 2022;26(9):889-95. DOI: https://doi.org/10.1007/s12603-022-1839-z
Johansen KL, Dalrymple LS, Glidden D, Delgado C, Kaysen GA, Grimes B, et al. Association of Performance-Based and Self–Reported Function–Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis. Clin J Am Soc Nephrol. 2016;11(4):626-32. DOI: https://doi.org/10.2215/CJN.03710415
Zhao Y, Liu Q, Ji J. The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. Int Urol Nephrol. 2020;52(1):115-20. DOI: https://doi.org/10.1007/s11255-019-02310-2
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8. DOI: https://doi.org/10.1007/s12603-012-0084-2
Arias-Rivera S, Sánchez-Sánchez MM, Jareño-Collado R, Raurell-Torredà M, Oteiza-López L, López-Cuenca S, et al. Fiabilidad intraobservador e interobservador de las escalas de fragilidad Clinical Frailty Scale-España y FRAIL-España en pacientes críticos. Med Intensiva. 2025;502131. DOI: https://doi.org/10.1016/j.medin.2024.502131
Fierro-Marrero J, Reina-Varona Á, Pardo-Montero J, Paris-Alemany A, La Touche R. Adaptation, development, validity, and reliability of the Escala Multidimensional de Fragilidad (EMFRA), and the 5-item FRAIL scale: a study design of the EMFRA project. J MOVE Ther Sci. 2024;6(1):639-52. DOI: https://doi.org/10.37382/jomts.v6i1.1158
Moreno LD, Ruiz CE, Urrego JC, Cadena MO, Maldonado SJ, Niño DA, et al. Frailty syndrome and end-stage kidney disease outcomes at a Latin American dialysis center. Biomédica. 2023;43(Sp. 3):S21-9. DOI: https://doi.org/10.7705/biomedica.7057
Moreno-Useche LD, Urrego-Rubio J, Cadena-Sanabria M, Rodríguez Amaya R, Maldonado-Navas S, Ruiz-González C. Frailty syndrome in patients with chronic kidney disease at a dialysis centre from santander, colombia. J Gerontol Geriatr. 2021;69(2):103-9. DOI: https://doi.org/10.36150/2499-6564-N249
Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3-10. DOI: https://doi.org/10.1016/j.ejim.2016.03.007
Johansen K, Chertow G, Jin C, Kutner N. Significance of frailty among dialysis patients. J Am Soc Nephrol JASN. 2007. DOI: https://doi.org/10.1681/ASN.2007020221
Painter P, Kuskowski M. A closer look at frailty in ESRD: getting the measure right. Hemodial Int Int Symp Home Hemodial. 2013;17(1):41-9. DOI: https://doi.org/10.1111/j.1542-4758.2012.00719.x
Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.a task force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29-37. DOI: https://doi.org/10.1007/BF02982161
López D, Flicker L, Dobson A. Validation of the frail scale in a cohort of older australian women. J Am Geriatr Soc. 2012;60(1):171-3. DOI: https://doi.org/10.1111/j.1532-5415.2011.03746.x
Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc. 2017;18(12):1082-6. DOI: https://doi.org/10.1016/j.jamda.2017.07.005
Chao CT, Chiang CK, Huang JW, Hung KY, COGENT study group. Self-reported frailty among end-stage renal disease patients: a potential predictor of dialysis access outcomes. Nephrol Carlton Vic. 2017;22(4):333-4. DOI: https://doi.org/10.1111/nep.12961