The Burden of Frailty on Mood, Cognition, Quality of Life, and Level of Independence in Patients on Hemodialysis: Regina Hemodialysis Frailty Study

摘要

English French Background: The prevalence of frailty is disproportionately increased in patients with chronic kidney disease (CKD) in comparison with non-CKD counterparts and is the highest in patients on hemodialysis (HD). While the cross-sectional measurement of frailty on HD has been associated with adverse clinical events, there is a paucity of data on longitudinal assessment of frailty and its relationship to outcomes. Objective: The objectives were to (1) evaluate changes in frailty status, level of independence, mood, cognition, and quality of life (QoL) over a 12-month period and (2) explore the relationship between frailty status and level of independence, mood, cognition, and QoL at 2 different time points (at baseline and at 1 year). Design: This is a prospective cohort study involving 100 prevalent HD patients. Setting: Regina General Hospital and Wascana Dialysis Unit in Regina, Saskatchewan, Canada, between January 2015 and January 2017. Patients: One hundred prevalent HD patients underwent frailty assessments using the Fried criteria at baseline and 1 year later. Measurements: Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Cognition, mood, and QoL were measured using questionnaires (Montreal Cognitive Assessment [MoCA], Geriatric Depression Scale [GDS], and EuroQol [EQ-5D] utility scores and visual analog scale [VAS], respectively). Methods: Frailty status was reported as a binary variable: frail vs. nonfrail (prefrail and robust). Differences across baseline and 1-year groups were assessed using McNemar’s test or Wilcoxon signed-rank test, as appropriate. We assessed the differences between frail and nonfrail groups using the Mann–Whitney U test or chi-square test/Fisher’s exact test where appropriate. Results: Ninety-seven of the 100 patients had complete initial assessments. The median (interquartile range [IQR]) duration of dialysis at baseline was 35.5 (13.75-71.75 months). One year later, 22 had died, 10 refused assessments, and 3 had relocated. In comparison with baseline vs 1 year, the number of frail patients was 68.1% vs. 67.7%; prefrail 26.8% vs. 26.1%; robust 5.1% vs. 6.2%; MoCA ≥24, 69% vs. 64.5%; GDS score ≥ 2, 52.8% vs. 47.7%; median EQ-5D utility score 0.81 vs. 0.77; and median EQ-VAS 60 vs. 50. Similarly, in comparison with baseline vs. 1 year, the number of independent patients was 82% vs. 63%, independent with support 17% vs. 31%, and long-term care home 0% vs. 3.1%. Eighteen of the 22 patients (82%) who died were frail. At 1 year, the median (IQR) MoCA was 24 (19-25) vs. 25 (21-26; P = .039) and median (IQR) GDS was 2 (1-3) vs. 1(0-2; P = .034). Likewise, median (IQR) EQ-5D utility score was 0.78 (0.6-0.82) vs. 0.81 (0.78-0.85; P = .023). There were significant changes in self-care (27% vs. 0%), P = 0.006, and daily activities (68.2% vs. 38.1%), P = 0.021. Limitations: This is a single-center study, so direct inferences must be interpreted in the context of the demographics of the study population. Patients were undergoing dialysis for a median of 36 months before undergoing initial assessment. Conclusions: Frailty and prefrailty in our dialysis patients is near-ubiquitous and will need to be proactively addressed to improve subsequent health care outcomes. Abrégé Contexte: La prévalence de la fragilité augmente de fa?on disproportionnée chez les patients atteints d’insuffisance rénale chronique (IRC) comparativement aux patients non-IRC, et est encore plus élevée chez les patients hémodialysés. Bien que la mesure transversale de la fragilité en hémodialyse soit associée à des événements cliniques indésirables, très peu de données existent sur cette mesure et sur son lien avec les résultats. Objectifs: Les objectifs étaient: 1) évaluer les changements dans l’état de fragilité, le niveau d’indépendance, l’humeur, la cognition et la qualité de vie (QdV) sur une période de 12 mois et; 2) explorer la relation entre l’état de fragilité et ces mêmes facteurs à deux moments précis, soit à l’inclusion et après un an. Type d’étude: étude de cohorte prospective portant sur 100 patients hémodialysés. Cadre: L’h?pital général et l’unité de dialyse Wascana Dialysis de Régina, en Saskatchewan (Canada) entre janvier 2015 et janvier 2017. Sujets: Les critères de Fried ont servi à évaluer la fragilité de 100 patients hémodialysés à l’inclusion et après douze mois. Mesures: La fragilité a été évaluée selon les critères de Fried, soit un questionnaire mesurant l’activité physique et le niveau d’épuisement per?u, ainsi que des évaluations pour une perte de poids involontaire, la faiblesse (force de préhension) et la lenteur (vitesse de marche). Des questionnaires ont servi à évaluer la cognition (Montreal Cognitive Assessment [MoCA]), l’humeur (échelle de dépression gériatrique [EDG]) et la QdV (scores d’utili