Introduction:
The number of elderly patients initiating dialysis has increased considerably over the past decade. This is the result of aging of the population, an increase in the prevalence of chronic kidney disease, earlier initiation of dialysis, and more liberal acceptance of elderly into dialysis programs. The frailty among this section of population is higher. The problems faced by the geriatric population is unique to them .The care giver burden is also different compared to the general population.
However, data on the prevalence of geriatric impairments and frailty in the elderly hemodialysis population is limited. The aim of this study is to assess the prevalence of geriatric impairments and frailty through a general assessment in a population of elderly patients (age>65 years)on hemodialysis
Methods:
Cross sectional study involving patients ≥65 years of age on maintanance Hemodialysis in a teritiary care centre in Chennai in India between September to November 2023.Demographic data, clinical and dialysis characteristic were collected from the medical chart and during the baseline assessment. Malnutrition is assessed by assessment of dietary intake, anthropometric measurements such as BMI, midarm circumference, triceps skin fold thickness, and nutritional scoring systems such as MIS, serum albumin levels and functional tests such as grip strength.
Definition of frailty with components that applied in the Cardiovascular Health Study by Fried et al, each of the five components included in the frailty is studied. Exhaustion is studied based on questions about endurance and energy from the Center for Epidemiologic Studies Depression (CES-D) scale. Low physical activity was acertained from the short version of the modified Minnesota Leisure Time Activity (MMLTA) questionnaire.
Results:
Thirty patients were included in the study with the mean age of 67.2±5.83 and 18 (60% ) patients were men . Geriatric impairments were highly prevalent. Most frequently impaired geriatric domains were functional performance(71.9%), depression(41%) and symptoms of cognitive decline(25%). Frailty was found among 65.2% patients.
Based on the BMI(Body Mass Index) 5(16%) of the patients are underweight, and 22(73%) patients are normal weight and 3(10%) patients were overweight .According to the mini nutritional assessment score one(0.3%) patient was malnourished , 19(63.3%) patients were under the risk of malnourished and 10(33%) patients had normal nutritional status.
No difference between frail and fit patients were found in demographics nor in the prevalence of impairment in cognition, symptoms of depression, malnutrition or Impairment in basic activities of daily living(p=0.76).
Conclusions:
Geriatric impairments are highly prevalent in patients ≥ 65 years old on chronic hemodialysis. Since impairments can be missed when not searched for in regular dialysis care, the first step of improving nephrological care is awareness of the extensiveness of geriatric impairment. Geriatric assessment in routine care appears promising to improve clinical outcomes in patients on hemodialysis. Further research is needed to develop a specific frailty indicator for this cohort of patients
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.