Department of Nephrology, Iqraa International Hospital and Research Center, Kozhikode, Kerala, India.
Department of Nephrology, Aster MIMS Hospital, Kozhikode, Kerala, India.
Saudi J Kidney Dis Transpl. 2020 Jul-Aug;31(4):767-774. doi: 10.4103/1319-2442.292310.
Data are scarce regarding the prevalence of frailty in elderly patients undergoing maintenance hemodialysis (HD) in India. We conducted a cross-sectional observational study aimed to study the prevalence of frailty and cognitive dysfunction in patients aged 75 years or more undergoing maintenance HD in three tertiary care hospitals and associated stand-alone dialysis centers in North Kerala. Frailty was ascertained by two methods. In method 1 (physical performance measurement based), dichotomous scoring (0 or 1) of five domains, namely weight loss, exhaustion, low physical activity, weak grip, and slow walking, was done, and a score of 3/5 was used to define frailty. In method 2 (self-report measure based), scores on the Medical Outcomes Study Short-Form 36-item Questionnaire (SF-36) physical function domain were used instead of hand grip strength and walking speed, and a score of <75 was defined as meeting the criteria for weakness and slow walking. Cognitive function was documented using the Montreal Cognitive Assessment Instrument. A total of 899 patients were screened, of whom 44 were aged 75 years or more and 39 met the criteria for inclusion. The majority (n = 31, 79.5%) had ages between 75 and 80 years and were male. Dialysis vintage was <1 year in 15.4%, 1-3 years in 51.3%, and >3 years in 33.3% of patients. Frailty was documented in 22 (56.4%) patients by method 1 and in 25 (64.1%) by method 2. There was a statistically significant difference between the two methods in documenting frailty (P < 0.001, Chi-square test). Cognitive impairment was present in 89.7% of patients and significantly associated with frailty (P < 0.001, Fisher's exact test). Frailty and cognitive dysfunction are highly prevalent in elderly people undergoing maintenance HD in North Kerala. Physical performance and self-report measure-based methods correlate well in frailty documentation.
在印度，接受维持性血液透析（HD）的老年患者中，衰弱的流行情况数据稀缺。我们开展了一项横断面观察性研究，旨在研究北喀拉拉邦 3 家三级护理医院和相关独立透析中心中年龄 75 岁及以上接受维持性 HD 的患者中衰弱和认知功能障碍的流行情况。通过两种方法确定衰弱情况。在方法 1（基于身体表现测量）中，对五个领域（即体重减轻、疲惫、低身体活动、握力弱和行走缓慢）进行二分制评分（0 或 1），并将 3/5 的评分用于定义衰弱。在方法 2（基于自我报告测量）中，使用医疗结局研究简表 36 项健康调查（SF-36）身体功能领域的评分代替握力和行走速度，将评分<75 定义为符合虚弱和行走缓慢的标准。使用蒙特利尔认知评估量表记录认知功能。共筛查了 899 名患者，其中 44 名年龄在 75 岁及以上，39 名符合纳入标准。大多数患者（n=31，79.5%）年龄在 75-80 岁之间，且为男性。15.4%的患者透析龄<1 年，51.3%的患者透析龄为 1-3 年，33.3%的患者透析龄>3 年。通过方法 1 记录了 22 名（56.4%）患者衰弱，通过方法 2 记录了 25 名（64.1%）患者衰弱。两种方法在记录衰弱方面存在统计学显著差异（P<0.001，卡方检验）。89.7%的患者存在认知障碍，且与衰弱显著相关（P<0.001，Fisher 确切检验）。北喀拉拉邦接受维持性 HD 的老年患者中衰弱和认知功能障碍非常普遍。身体表现和自我报告测量为基础的方法在衰弱记录方面相关性良好。
