THE SPECTRUM OF FRAILTY AND QUALITY OF LIFE AMONG HEMODIALYSIS PATIENTS IN A TERTIARY HOSPITAL IN SOUTH INDIA

 

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THE SPECTRUM OF FRAILTY AND QUALITY OF LIFE AMONG HEMODIALYSIS PATIENTS IN A TERTIARY HOSPITAL IN SOUTH INDIA

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Parth
Vhora
Parth Vhora parthvhora@gmail.com Christian medical college Nephrology Vellore India *
Selvin Sundar Raj selvinsr@gmail.com Christian medical college Nephrology Vellore India -
Nisha Jose josenisha2000@gmail.com Christian medical college Nephrology Vellore India -
Joseph Johny josephjohny1857@gmail.com Christian medical college Nephrology Vellore India -
Jeethu Joseph Eapen jjeapen@gmail.com Christian medical college Nephrology Vellore India -
Santosh Varughese santosh.vellore@gmail.com Christian medical college Nephrology Vellore India -
Suceena Alexander suceena@gmail.com Christian medical college Nephrology Vellore India -
Vinoi George David vinoigd@hotmail.com Christian medical college Nephrology Vellore India -
Athul Thomas thomasathul1@gmail.com Christian medical college Nephrology Vellore India -
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End stage kidney disease patients on maintenance hemodialysis have poor quality of life and increasing prevalence of frailty. Both these factors are usually neglected and affect the well- being of these patients.

Frailty is defined as medical syndrome characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and death. Frailty causes increased incidence of hospitalizations, physical disability, and reduced capacity to activities of daily living . Frailty is often seen as a clinical syndrome, with heightened vulnerability, susceptibility to minor stress, and the potential to compromise functional abilities. It causes increased incidence of hospitalizations, physical disability, and reduced capacity to activities of daily living and death. Although frailty is associated with advanced age, certain conditions like end stage kidney disease which produce changes like aging can lead to frailty state at younger ages. Given the link between frailty and unfavorable outcomes, more effort in identifying frail dialysis patients is important and developing an effective frailty management approach, including risk factor management that may accelerate its progression need to be identified early.

Health related quality of life is a multidimensional, dynamic encompassing physical health and symptoms, functional status, mental well-being, and social functioning. Long-term dialysis therapy frequently causes a loss of independence, reliance on caretakers, disturbance of marital, familial, and social life. Hence, it is an important outcome measure in hemodialysis patients and the major therapeutic goal is to improve the functioning ability of these patients so that they can enjoy life to its fullest possible extent. Assessment of quality of life in hemodialysis patients not only helps to assess the quality of dialysis program but also helps to develop better care and interventions in future to improve the quality of life.

This observational study aims to evaluate the prevalence of frailty and its association with quality of life in hemodialysis patients.

We recruited 176 patients on maintenance hemodialysis for more than 3 months. Demographic information was collected from each participant including age, gender, educational qualification, economic status, marital status, and occupation. Medical history including native kidney disease, comorbidities like hypertension and diabetes, dialysis vintage and vascular access was taken from the medical records of the patient. Dialysis related parameters like interdialytic weight gain, adequacy of dialysis by urea kinetic model estimation (Kt/v) and intradialytic hypotension was also assessed.

Prevalence of frailty was assessed using Fried’s frailty phenotype along with clinical frail scale and Edmonton frailty scale. Their quality of life was assessed using the SF-36 and WHO-quality of life scale. All the continuous variables were reported using mean (SD) or median (IQR). All categorical variables were reported using frequency and percentages.All analysis was performed using STATA version 16.0.

176 176 patients were recruited for the study. The mean age of the participants was 43+/-15 years. There were 134 males and 42 females in the study. 23% of the participants had a Charlson comorbidity index of >5. The Prevalence of frailty among the subjects was 50% according to the fried frailty phenotype. The participants had poor mean scores in physical functioning ( 49+/-21) , physical health (51+/-16) ,psychological health ( 57+/-17) and reported higher pain scores of (64+/-22).

A large proportion of end stage renal disease patients are frail and lead a poor quality of life. Given the link between frailty and unfavorable outcomes, more effort should be taken in

identifying frail dialysis patients. Developing an effective frailty management approach, especially in those who are older, diabetic and have a Charlson comorbidity index of >5.

Kewords