FRAILTY AND MORTALITY IN PATIENTS WITH DIALYTIC THERAPY: A PROSPECTIVE COHORT STUDY

Chronic kidney disease (CKD) is associated with aging-like manifestations, and its assessment is not routinely performed. There is limited data on these assessments in Latin-Americans. The purpose of this study was to explore frailty prevalence, according to Fried criteria, and its association to all-cause mortality.

We performed an observational prospective cohort to compare frailty and all-cause mortality in patients receiving either peritoneal dialysis (PD) or hemodialysis (HD). From January to December 2019-2021, we included adult patients with CKD stage 5 in dialytic therapy at least for three months, with prior consent to participate, from the Regional Center for Renal Diseases of the University Hospital “José Eleuterio González.” Exclusion criterion consisted in those comorbidities that prevented testing. Sociodemographic and baseline biochemical variables were recorded at the time of physical variables measurement. Frailty was assessed based on Fried criteria. We also evaluated Charlson comorbidity index, Barthel and Katz index.

A total of 117 patients were included, 73 patients on HD and 42 on PD. Mean age was 49 ±14.4; 55.5% were male. Main cause for CKD was diabetic nephropathy. Baseline biochemical variables in both groups showed significant differences in lymphocyte, serum albumin, calcium, magnesium, and phosphorus levels, with levels lower in PD patients. Katz assessments showed that 94.7% (n=71) of HD patients had no or low disability, while in PD the figure was 92.9% (n=39), with a significant trend at p=0.07. The Barthel index showed independence in 52% (n=39) of HD patients and in 59.9% (n=25) of PD patients. Patients with HD indication had significant lower means of peak force in both hands. Of the patients 64% of HD patients were frail (n=48) they met three or more criteria, while in PD 54.8% (n=23) met one or two criteria and were classified as pre-frail (p=0.07). 67.7% (n=44) of men were frail, while 51.9% (n=27) of women were pre-frail. Most patients had no/low incapacity according to Katz Evaluation, independent by the Barthel Index. All-cause mortality was not significantly different between groups Main cause of death in patients in both groups were cardiovascular events 12% in HD and in 9.5% PD . Mortality was higher in HD patients (29.7% (n=23), although not significant. Mortality was higher in frail HD patients (n=15, 31.3%), while pre-frail PD patients (n=8,34.8%,p=0.54). Multivariate analysis showed a 2.9% increase in mortality for each year of age (HR 1.029, p=0.04, 95% CI 1.001-1.056).

This study provides crucial insights into frailty profiles and mortality over a median follow-up of 402 days. Although sociodemographic and functional characteristics were comparable between groups, significant differences were observed in laboratory parameters, reflecting distinct physiological profiles that may influence treatment outcomes. HD patients showed greater frailty according to the Fried scale, without statistical significance, and all-cause mortality rates were similar between groups, suggesting that accurately measured frailty may not be a determining factor for survival differences in this cohort. Patient-centered care is essential to address risk factors before and during dialytic therapy.