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      Frail Patient in Hemodialysis: A New Challenge in Nephrology—Incidence in Our Area, Barcelonès Nord and Maresme

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          Abstract

          Introduction

          Labeling a patient as “frail” may be useful in assessing the prognosis and therapeutic approach.

          Objective

          The aim of the study is to define a pattern of frailty among our dialysis population, to analyse the incidence and clinical evolution of these patients.

          Materials and Methods

          We analysed a total of 320 patients with stage V chronic kidney disease (CKD) who were on hemodialysis between September 2014 and September 2015. To define a patient as frail we used the Fried phenotype model, and we added a new criteria-dialysis session length longer than 12 hours/week.

          Results

          5.6% of the 320 patients were frail. We found statistically significant differences regarding body mass index (BMI), hemoglobin (Hgb), and serum albumin, as well as the ability to perform the basic activities of daily living ( p < 0.005), ability to ambulate ( p = 0.01) and perform transfers ( p < 0.005). We found statistically significant differences between the two groups in terms of hospital admissions ( p = 0.005) and mortality ( p < 0.005).

          Conclusion

          5.6% of the study population were frail, with lower BMI, serum albumin and hemoglobin, lower capacity for basic activities of daily living, ambulation, and transference, as well as higher morbidity and mortality.

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          Most cited references20

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          Significance of frailty among dialysis patients.

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            Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association.

            In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.
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              Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis.

              To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization. Prospective cohort study. Single hemodialysis center in Baltimore, Maryland. One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012. Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations. At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P = .046) and 2.6 times (95% CI = 1.04-6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants. Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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                Author and article information

                Contributors
                Journal
                J Aging Res
                J Aging Res
                JAR
                Journal of Aging Research
                Hindawi
                2090-2204
                2090-2212
                2017
                28 September 2017
                : 2017
                : 7624139
                Affiliations
                1Nephrology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
                2Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Can Ruti Campus, Badalona, Spain
                3Agència de Gestió d'Ajuts Universitaris i de Recerca- (AGAUR-) REMAR, Barcelona, Spain
                4Red Investigación Renal (REDinREN), Instituto Salud Carlos III, Madrid, Spain
                5Diaverum Renal Services, Madrid, Spain
                Author notes

                Academic Editor: Jean-Francois Grosset

                Author information
                http://orcid.org/0000-0002-6799-2169
                Article
                10.1155/2017/7624139
                5637862
                29093973
                056600ec-370e-4fd8-809b-43a7869ef424
                Copyright © 2017 Ioana Bancu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2017
                : 9 August 2017
                : 20 August 2017
                Categories
                Research Article

                Molecular medicine
                Molecular medicine

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