Zemp Damiano D, Giannini Olivier, Quadri Pierluigi, Tettamanti Mauro, Berwert Lorenzo, Lavorato Soraya, Pianca Silvio, Solcà Curzio, de Bruin Eling D
Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.
Service of Geriatrics, EOC, Ospedale Regionale di Mendrisio EOC, Mendrisio, Switzerland.
Front Med (Lausanne). 2022 Feb 4;9:682198. doi: 10.3389/fmed.2022.682198. eCollection 2022.
Patients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.
The patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.
At baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score ( < 0.01, = 8.50) and the number of comorbidities ( = 0.01, = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.
Our results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.
终末期肾病患者已知特别虚弱，其病因仍被广泛认为与肾脏替代治疗中的特定因素直接相关。然而，仔细研究从透析前到长期血液透析的过渡阶段会得出有争议的解释，因为虚弱过程在肾功能不全的早期阶段就已得到充分描述。本研究旨在纵向和多因素地描述从决定开始替代治疗到血液透析2年结束这一期间的变化。我们假设虚弱在透析前阶段就已存在，并且不会随着替代治疗的开始而恶化。在2015年至2018年期间，我们在一个透析前项目中招募了25名患者（72.3±5.7岁），预计替代治疗将在未来几个月内开始。
患者在开始血液透析前进行一次基线访视，并在治疗的前2年进行4次随访。在研究期间监测健康状况、身体机能、认知功能、血液学参数和不良事件。
在基线时，我们的样本具有高度变异性，患者范围从极度虚弱到非常健康。在14名未退出研究的参与者中，在32项临床和功能指标中，仅在短身体机能测试电池（SPPB）评分（<0.01，=8.50）和合并症数量（=0.01，=3.94）方面观察到有统计学意义的恶化。然而，仔细分析发现，对于虚弱和健康的参与者来说，替代治疗的第一年情况相当稳定，而在第二年，虚弱参与者的情况会恶化，甚至可能导致死亡。
我们的结果应促使重新评估透析前项目在减少过渡阶段并发症方面的作用，同时也应重新评估血液透析开始后针对虚弱和健康患者的虚弱预防项目，以维持令人满意的健康状况。
