Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions

Autor: Marta Arias-Guillén, Bárbara Romano, Anna Yuguero-Ortiz, Ana López-Lazcano, Sonia Guerrero, Vanesa Villegas, Mar Martínez, Nuria Clemente, Miquel Gómez, Lida Rodas, José Jesús Broseta, Marta Quintela, Francesc Maduell, Beatriu Bayés
Rok vydání: 2023
Předmět:
Zdroj: Clinical Kidney Journal.
ISSN: 2048-8513
2048-8505
DOI: 10.1093/ckj/sfad115
Popis: Background The number of frail patients of advanced age with end-stage chronic kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score [MIS]; protein-energy wasting), physical (short physical performance battery [SPPB]), and psychological status. Results A total of 167 patients (mean age, 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail, and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based, or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (p = 0.025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists, and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped advising patients on individual nutritional, physical or psychological needs.
Databáze: OpenAIRE
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