Abstract: TH-PO251
Frailty in Prevalent Hemodialysis Patients: Regina Frailty Study
Session Information
- Hemodialysis and Frequent Dialysis - II
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Jafari, Maryam, RQHR- Research and Performance Support, Regina, Saskatchewan, Canada
- Tondon, Kavaljeet Kour, RQHR- Research and Performance Support, Regina, Saskatchewan, Canada
- Prasad, Bhanu, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
Background
Frailty is characterized by accumulating physiological deficits in patients across many domains and puts individuals at a higher risk of poor health outcomes. The prevalence of frailty is disproportionately increased in patients on Hemodialysis (HD) when measured either at entry to the dialysis unit or once stabilized on HD. However, trajectory of frailty on serial measurements and its relationship to level of independence, cognition, quality of life (QoL) and mood has not yet been explored.
Methods
We conducted a prospective longitudinal study amongst 100 prevalent HD patients at the Regina General Hospital, Canada from Jan 2015 to Jan 2016. Patients were reevaluated one year after the initial assessment. Four levels of dependence were defined: independent, independent with family support, requiring home care assistance, and long-term care home resident. Frailty was measured using the Fried Criteria (score of ≥3/5), cognitive function was assessed with Montreal Cognitive Assessment, mood was assessed using the Geriatric Depression Scale and QoL was measured with EuroQol-5D at each assessment. To determine associations, chi square and McNemar’s tests were used.
Results
At baseline, the mean age was 62.86 ± 15.44 years, 58% were men, and majority (73%) were Caucasian. 68% were frail, 53% screened positive for depressive symptoms and 69% had impaired cognitive function. After one year, the % of independent patients decreased (81.5% vs. 63.1%), and more patients required additional support at home (17% vs. 31%). Higher proportion of patients experienced challenges with mobility (67.7% vs. 83.1%, p= 0.02), as well as with self– care (6.2% vs. 18.5%, p=0.02). Non–frail patients had more favorable cognition scores in comparison to the frail cohort [24 (21–26) vs. 21 (15–24), p=0.006]. Of the 21 patients who died at one year follow up, 62% were frail.
Conclusion
Two thirds of established dialysis patients met the criteria for frailty. Frail patients are more likely to be dependent on their family members and need greater number of support systems in place. The collective impact of multiple comorbidities, depression, cognitive impairment, reduced QoL and frailty on HD patients, and its consequent impact on health care delivery will have to be proactively addressed in a multidisciplinary manner. We suggest sequential frailty measurements in HD units to improve care delivery of patients.