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Fragility is characterized by a decrease in cognitive and physiological reserves leading to increased vulnerability. Frailty is more prevalent in patients in all stages of chronic kidney disease (CKD) and in two thirds of patients with CKD5. It is associated with a higher risk of hospitalizations, disability, and mortality. The Objective of the study is to evaluate the functional capacity of patients with CKD on a chronic hemodialysis (HD) with an age greater than or equal to 75 years. Secondly to evaluate the relationship between functional capacity and vascular access for dialysis.
An observational, descriptive, cross-sectional study to access the absolute and relative frequency of variables related to functional capacity and health status.
Population: Patients on HD for over 3 months, who agree to be included in the study with age over and equal to 75 years.
Patients included were evaluated by geriatrics, nutritionists, nephrologists and nephrology nurses through the application of five scores (FRAIL, Minimental, MIS, Barthel, Charlson) in the population from August through September 2023. Barthel test was adapted for patients with no urine output.
Data Analysis: Quantitative data was expressed as mean and Standard deviation (SD) or median and interquartile range (IQR) and qualitative data as percentage. Comparison was done by Student T test or chi square as appropriated.
Were included 59 patients (Pts), mean age 82.2 ± 5.0 (range 75 – 93 years), 35 men (59.3%), 28 diabetics (47.5%) with HD vintage of 39.3 ± 31.3 months. Of them 40 Pts (67.8%) had an AVF or graft and 19 (32.2%) a permanent catheter (CVC).
Charlson index ranged from 4 to 10, median 7 (IQR 5-9). Mini – mental test ranged from 8 to 30, with 20 Pts (35.7%) less than 24, median 26 (IQR 22-26). Frail score mas median 2 (IQR1-3). Barthel score was mean 77.5 ± 31.9, with median value of 95 (IQR 60-100).
Patients with CVC had significant higher age (84.4 vs 81.2), higher Frail score (2.47 vs 1.59) and higher MIS score (11.3 vs 8.7), and Lower Barthel test (60.5 vs 80.6).
With no difference in Charlson or Mini – mental scores with vascular access.
A Mini mental test over 24 was significantly associated with lower HD vintage (35.4 vs 45.7 months), lower Frail index and higher mean Barthel score (88.8 vs 51.2), with no significant difference in age, Charlson index, or MIS.
Elderly Pts should be screened for functional capacity in order to implement adequate strategies to reduce morbidity and mortality. Vascular access type was found related to Functional Capacity.