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      Factores asociados a la fragilidad en el paciente en tratamiento renal sustitutivo con diálisis. Una revisión sistemática Translated title: Factors associated with frailty in patients on renal replacement therapy with dialysis. A systematic review

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          Abstract

          Resumen Introducción: La fragilidad es un síndrome multidimensional caracterizado por una disminución de reservas fisiológicas, de masa corporal magra, debilidad y disminución de resistencia al ejercicio físico. Sitúa a la persona en una situación de mayor vulnerabilidad ante factores externos, además existe una estrecha relación entre la fragilidad y las enfermedades crónicas, como es el caso de la enfermedad renal crónica. Objetivo: El objetivo principal de esta revisión fue sintetizar y conocer la evidencia científica sobre los factores asociados a la fragilidad de los pacientes con enfermedad renal crónica en tratamiento renal sustitutivo en diálisis. Material y Método: Se llevó a cabo una revisión sistemática a través de las bases de datos de Pubmed y Proquest. Se incluyeron artículos originales en inglés y español publicados entre 2015 y 2020, y se analizaron los artículos que trataban sobre fragilidad en el paciente con enfermedad renal en tratamiento sustitutivo. Se excluyeron aquellos artículos que no presentaron resultados. Resultados: Se incluyeron 26 artículos de diseño observacional. Los hallazgos se enfocan a la prevalencia, mortalidad, tasa de hospitalización, discapacidad, deterioro cognitivo, síntomas depresivos, obesidad, comorbilidades, caídas o fracturas y actividad y rendimiento físico. Conclusiones: Se ha encontrado una elevada prevalencia de fragilidad en el enfermo renal crónico en tratamiento renal sustitutivo con diálisis, sin diferencias entre diálisis peritoneal y hemodiálisis. La fragilidad en estos pacientes está asociada a mayor mortalidad, tasa de hospitalización, discapacidad, deterioro cognitivo, síntomas depresivos y comorbilidades. La actividad y rendimiento físico, parecen ser factores que disminuyen la fragilidad.

          Translated abstract

          Abstract Introduction: Frailty is a multidimensional syndrome characterized by a decrease in physiological reserves, lean body mass, weakness and decreased resistance to physical exercise. It places the person in a situation of greater vulnerability to external factors, in addition there is a close relationship between frailty and chronic diseases, such as renal insufficiency chronic. Objective: The main objective of this review was to synthesize and know the scientific evidence on the factors associated with the frailty of patients with renal insufficiency chronic in renal replacement therapy with dialysis. Material and Method: A systematic review was carried out using the PubMed and ProQuest databases. Original articles in English and Spanish published between 2015 and 2020 were included, and articles dealing with frailty in patients with renal disease on renal replacement therapy were analysed. Articles that did not present results were excluded. Results: 27 observational design articles were included. The findings focus on prevalence, mortality, hospitalization rate, disability, cognitive decline, depressive symptoms, obesity, comorbidities, falls or fractures, and physical activity. Conclusions: A high prevalence of frailty has been found in the chronic renal patient in replacement therapy with dialysis, without differences between peritoneal dialysis and hemodialysis. Frailty in these patients is associated with higher mortality, hospitalization rate, disability, cognitive decline, depressive symptoms and comorbidities. Physical activity and performance appear to be factors that decrease frailty.

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          Most cited references54

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          Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care

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            Significance of frailty among dialysis patients.

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              The presence of frailty in elderly persons with chronic renal insufficiency.

              Frailty has been defined as a tool to define individuals who lack functional reserve and are at risk for functional decline. We hypothesized that chronic renal insufficiency (CRI) would be associated with a greater prevalence of frailty and disability in the elderly. This cross-sectional analysis used baseline data collected from the Cardiovascular Health Study, which enrolled 5,888 community-dwelling adults aged 65 years or older from 4 clinical centers in the United States. Renal insufficiency is defined as a serum creatinine level of 1.3 mg/dL or greater (> or =115 micromol/L) in women and 1.5 mg/dL or greater (> or =133 micromol/L) in men. Frailty is defined by the presence of 3 of the following abnormalities: unintentional weight loss, self-reported exhaustion, measured weakness, slow walking speed, and low physical activity. Disability is defined as any self-reported difficulty with activities of daily living. Among 5,808 participants with creatinine levels measured at entry, 15.9% of men (n = 394) and 7.6% of women (n = 254) had CRI. Prevalences of frailty (15% versus 6%; P < 0.001) and disability (12% versus 7%; P = 0.001) were greater in participants with CRI compared with those with normal renal function. After multivariate adjustment for comorbidity, CRI remained significantly associated with frailty (odds ratio, 1.76; 95% confidence interval, 1.28 to 2.41), but not disability (odds ratio, 1.26; 95% confidence interval, 0.94 to 1.69). Elderly persons with CRI have a high prevalence of frailty, which may signal their risk for progression to adverse health outcomes. If confirmed in other studies, identification of frailty in patients with CRI may warrant special interventions to preserve their independence, quality of life, and survival.
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                Author and article information

                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                September 2021
                : 24
                : 3
                : 233-248
                Affiliations
                [1] Andalucía orgnameUniversidad de Córdoba orgdiv1Departamento de Enfermería orgdiv2Facultad de Medicina y Enfermería Spain
                [2] orgnameHospital Universitario Reina Sofía de Córdoba orgdiv1Servicio de Nefrología España
                [3] orgnameInstituto Maimónides de Investigación Biomédica de Córdoba España
                Article
                S2254-28842021000300233 S2254-2884(21)02400300233
                10.37551/s2254-28842021021
                b4f45fe7-9190-483b-93b5-47f020bbbac4

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 30 August 2021
                : 02 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 57, Pages: 16
                Product

                SciELO Spain

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                frailty,hemodiálisis,diálisis peritoneal,tratamiento renal sustitutivo,enfermedad renal crónica,fragilidad,hemodialysis,peritoneal dialysis,renal replacement therapy,chronic kidney disease

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