FRAILTY IN HEMODIALYSIS POPULATION ATTENDING A TERTIARY CARE HOSPITAL IN NORTH INDIA – AN OBSERVATIONAL STUDY

Introduction:

Frailty is a state of increased vulnerability to adverse health outcomes, characterized by a decline in physiological reserves and impaired ability to respond to stressors . In the context of end-stage renal disease (ESRD) patients undergoing hemodialysis, frailty has emerged as a significant concern. The prevalence of frailty in this population is alarmingly high, with studies reporting rates ranging from 30% to over 70%. We aim to bridge the knowledge gap and provide a comprehensive overview of the current understanding of frailty in hemodialysis patients, including its prevalence, risk factors, impact on clinical outcomes. By highlighting the importance of this issue we hope to contribute to the ongoing efforts to improve the overall health care and outcomes of hemodialysis patients.

Methods:

In this cross-sectional study, a total of 200 patients undergoing maintenance hemodialysis were screened between June 2022 and December 2023, with 170 patients meeting the eligibility criteria and completing frailty assessments. Patients with of age more than 18 years, undergoing same modality of hemodialysis for at least 3 months were included. Patients were excluded if they were younger than 18 years, those who did not complete the frailty assessment and those with active infection. Frailty was evaluated using the Fried Frailty Phenotype and the Clinical Frailty Scale (CFS). For the purpose of analysis, all patients were categorised into 2 categories – frail and non-frail. Non-frail category included both pre-frail and non-frail as per Frail’s phenotype. Demographic, clinical, and laboratory data were collected to identify potential risk factors. Study was approved by Institutional Ethical Committee.

Results:

The prevalence of frailty was 49.4%, with significant differences observed based on age and gender. Frail patients were older (mean age 42.3 years) and predominantly female (79.1%). The prevalence of frailty was greater in patients with diabetes (p=0.007), hypothyroid(p=<0.001) and coronary artery disease(p=0.004). Patients with longer dialysis vintage (p<0.001) and intra-dialytic hypotension (p=0.001) were more likely to be frail. We found that frail patients had lower MUAC (p=0.05), lower albumin levels(p<0.001) and lower total cholesterol levels(p<0.004). On multivariate logistic regression analysis identified independent predictors of frailty: female gender (OR=4.794, p=0.004), age over 37 years (OR=5.993, p=0.001), MUAC <22 cm (OR=4.238, p=0.005), serum albumin <4 g/dL (OR=5.11, p<0.001), total cholesterol <150 mg/dL (OR=2.758, p=0.032), presence of intradialytic hypotension (OR=4.651, p=0.033), and hypothyroidism (OR=6.074, p=0.046). The CFS demonstrated a sensitivity of 52.38% and specificity of 94.19% compared to the Fried phenotype criteria. 

Conclusions:

Frailty is highly prevalent among hemodialysis patients in North India. The findings reveal that frailty is associated with several modifiable factors, including female gender, older age, low MUAC, low albumin and total cholesterol levels, and the presence of comorbidities such as diabetes, hypothyroidism and coronary artery disease. The results highlights the importance of early identification and assessment of frailty in hemodialysis patients to facilitate timely interventions aimed at improving their overall health outcomes and quality of life. Implementing targeted strategies, such as nutritional support and physical rehabilitation, may help mitigate the adverse effects of frailty and enhance patient care in this vulnerable population.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.