Date Published: April 1, 2018
Publisher: JKL International LLC
Author(s): Hidemi Takeuchi, Haruhito A. Uchida, Yuki Kakio, Yuka Okuyama, Michihiro Okuyama, Ryoko Umebayashi, Kentaro Wada, Hitoshi Sugiyama, Ken Sugimoto, Hiromi Rakugi, Jun Wada.
The population undergoing dialysis is aging worldwide, particularly in Japan. The clinical condition of frailty is the most problematic expression in the elderly population. Potential pathophysiological factors of frailty present in patients with CKD and are accentuated in patients with ESRD. The aim of this study was to identify the prevalence and predictors of frailty in Japanese HD patients. This study was a multicenter, cross-sectional and observational investigation conducted at 6 institutions. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese as the self-reported questionnaire was used. Of the 542 patients visiting each institution, 388 were enrolled in this study. In total, 26.0% of participants were categorized as not-frailty, 52.6% as pre-frailty and 21.4% as frailty. The prevalence of frailty increased steadily with age and was more prevalent in females than in males and the subjects with frailty received polypharmacy. A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: female gender (odds ratio [OR] = 3.661, 95% confidence interval [CI] 1.398-9.588), age (OR = 1.065, 95% CI 1.014-1.119), age ≥ 75 years old (OR = 4.892, 95% CI 1.715-13.955), body mass index (BMI) < 18.5 (OR = 0.110, 95% CI 0.0293-0.416), number of medications being taken (OR = 1.351, 95% CI 1.163-1.570), diabetes mellitus (DM) (OR = 2.765, 95% CI 1.081-7.071) and MNA-SF ≤ 11 (OR = 7.405, 95% CI 2.732-20.072). Frailty was associated with the accumulation of risk factors. The prevalence of frailty in Japanese patients with HD was relatively lower than that previously reported in Western developed countries; however, it was extremely high compared to the general population regardless of age. Our findings suggest that frailty might be associated with an increase in the prevalence of adverse health outcomes in patients with HD.
To our knowledge, this is the first investigation concerning the prevalence of frailty among Japanese prevalent patients with chronic HD. This study demonstrated that the proportion of patients meeting the self-reported functional-based definition of frailty, was markedly higher than that of the community-dwelling elderly population [13, 14]: approximately 3 to 4 folds higher. In contrast, the prevalence of frailty with HD patients in this study was relatively lower than that noted in previous studies in other developed countries: 21.4% in this study vs around 42-73% in other developed countries [9, 21-25], despite that Japanese dialysis population are older compared with other developed countries . In addition, the proportion of HD patients with frailty was higher among non-elderly individuals than among those in the community-dwelling population. Predictors of frailty were almost the same as previously reported [3, 21, 27]. Age (especially 75 years old and above), female gender, the number of medicine, DM and MNA-SF ≤ 11 (at risk of malnutrition) were independently and significantly associated with frailty. Furthermore, the accumulation of risk factors for frailty was observed in frail patients. These risk factors are generally related to disability, mortality and several complications. Therefore, this indicates that the patients with frailty might be associated with an increased prevalence of adverse health outcomes in patients with HD. Although we have not yet performed a further longitudinal investigation, these findings suggest that frailty might affect the prognosis and quality of life (QOL) of patients with HD.