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Fragility is a multifactorial syndrome characterized by a decrease in resistance, strength, and physiological function, making the patient more vulnerable and dependent, thereby increasing mortality. This syndrome is more prevalent in the elderly and in patients with chronic kidney disease, particularly those undergoing hemodialysis.
It is documented (1) that the prevalence of the fragility phenotype in adult patients with chronic kidney disease who are not undergoing dialysis (14%) is higher than the general population (7%). On the other hand, the prevalence of fragility in patients with chronic hemodialysis is around 42% (35% in young adults and 50% in the elderly), with a probability of 29%. A frail phenotype has a 2.6 times higher risk of mortality and a 1.43 times higher number of hospitalizations, regardless of age, comorbidity, and disability.
A cross-sectional study was conducted with 73 patients undergoing chronic hemodialysis, all of whom were affiliated with the Nephrology and Hemodialysis Center in Tarija, during the period from July 2022 to January 2023. Only patients with a history of more than 3 months at the center were included in the study, all of whom were over 18 years old and agreed to participate by signing the designated consent form. One patient was excluded due to terminal illness, resulting in a cohort of 72 prevalent hemodialysis patients.
The sociodemographic data of each patient were recorded, along with some laboratory values (hematocrit, hemoglobin, creatinine, urea, calcium, phosphorus, albumin). The CFS (Clinical Frailty Scale) by Rookow et al. (2007) in Spanish was applied to assess biological frailty. Statistical analyses were conducted using ANOVA and t-tests.
A total of 72 patients undergoing chronic hemodialysis were included and divided into two groups: young adult patients (18–64) and elderly patients (≥65 years), with an average age of 46.9 ± 12 years and 70.5 ± 4.8 years, respectively. The prevalence of frailty was 69% among the total number of patients attending chronic hemodialysis at the San Juan de Dios Regional Hospital.
There was a predominance of women in both groups, with 62% in the adult group and 61% in the elderly group. The presence of comorbidities showed similar proportions in both groups, including diabetes mellitus, hypertension, and heart failure.
Stroke was prevalent only in the elderly group with a significant p-value of 0.04. As a marker of functionality, the Clinical Frailty Scale (CFS) was higher in both age groups (CFS value >3) compared to the reference value (<3 in healthy individuals).
The CFS value was higher in elderly patients (5.7 ± 0.8) compared to young patients (4.2 ± 1.3), with a p-value of <0.001. Finally, when evaluating serum parameters, hemoglobin, hematocrit, and albumin were reduced, while creatinine and urea were elevated in all three groups. There was no statistically significant difference between the studied groups, either when considered individually or when grouped according to the frailty scale.
A prevalence of 69% was found among a total of 72 patients undergoing chronic hemodialysis at our hospital, demonstrating a high prevalence of frailty even in patients who are not in advanced stages of life. The majority of patients in both groups were women, and a similar prevalence of type 2 diabetes mellitus and hypertension was found. Additionally, a high prevalence of stroke was observed in the elderly group.
Regarding laboratory results, low levels of creatinine were found in the elderly group, which may be explained by a higher level of sarcopenia in this group. This decrease in muscle mass directly affects the values obtained. Regarding the frailty scale (CFS) applied in the study, frailty was found in the young group, and this prevalence increased significantly in the elderly group. These findings negatively reflect the influence of chronic kidney disease on the deterioration of muscle function and functional dependence in hemodialysis.