Hendra Heidy, Sridharan Sivakumar, Farrington Ken, Davenport Andrew
UCL Department of Nephrology, University College London, London NW, UK.
University of Hertfordshire, Hatfield, UK.
Gerontol Geriatr Med. 2022 May 6;8:23337214221098889. doi: 10.1177/23337214221098889. eCollection 2022 Jan-Dec.
Both frailty and cachexia increase mortality in haemodialysis (HD) patients. The clinical frailty score (CFS) is a seven-point scale and less complex than other cachexia and frailty assessments. We wished to determine the characteristics of frail HD patients using the CFS. Single centre cross-sectional study of HD patients completing physical activity questionnaires with bioimpedance measurements of body composition and hand grip strength (HGS). We studied 172 HD patients. The CFS classified 54 (31.4%) as frail, who were older (70.4±12.2 vs 56.2 ± 16.1 years, < 0.001), greater modified Charlson co-morbidity (3 (2-3) versus 1.5 (0-3), < 0.001), and body fat (33 (25.4-40.2) versus 26.2 (15.8-34) %, < 0.01), but lower total energy expenditure (1720 (1574-1818) versus 1870 (1670-2194) kcal/day, < 0.01), lean muscle mass index (9.1 (7.7-10.1) versus 9.9 (8.9-10.8) kg/m2), and HGS (15.3 (10.3-21.9) versus 23.6 (16.7-34.4) kg), both < 0.001. On multivariable logistic analysis, frailty was independently associated with lower active energy expenditure (odds ratio (OR) 0.98, 95% confidence limits (CL) 0.98-0.99, = 0.001), diabetes (OR 5.09, CL 1.06-16.66) and HGS (OR 0.92, CL 0.86-0.98). Frail HD patients reported less active energy expenditure, associated with reduced muscle mass and strength. Frail patients were more likely to have greater co-morbidity, particularly diabetes. Whether physical activity programmes can improve frailty remains to be determined.
衰弱和恶病质都会增加血液透析（HD）患者的死亡率。临床衰弱评分（CFS）是一个七分制量表，比其他恶病质和衰弱评估方法更简单。我们希望使用CFS来确定衰弱HD患者的特征。对完成体力活动问卷并进行身体成分生物电阻抗测量和握力（HGS）测量的HD患者进行单中心横断面研究。我们研究了172例HD患者。CFS将54例（31.4%）患者分类为衰弱，这些患者年龄更大（70.4±12.2岁对56.2±16.1岁，<0.001），改良Charlson合并症更多（3（2 - 3）对1.5（0 - 3），<0.001），体脂更高（33（25.4 - 40.2）%对26.2（15.8 - 34）%，<0.01），但总能量消耗更低（1720（1574 - 1818）千卡/天对1870（1670 - 2194）千卡/天，<0.01），瘦肌肉质量指数更低（9.1（7.7 - 10.1）对9.9（8.9 - 10.8）kg/m²），HGS更低（15.3（10.3 - 21.9）对23.6（16.7 - 34.4）kg），均<0.001。在多变量逻辑分析中，衰弱与较低的活动能量消耗独立相关（比值比（OR）0.98，95%置信区间（CL）0.98 - 0.99，P = 0.001）、糖尿病（OR 5.09，CL 1.06 - 16.66）和HGS（OR 0.92，CL 0.86 - 0.98）。衰弱的HD患者报告的活动能量消耗较少，与肌肉质量和力量降低有关。衰弱患者更可能有更多合并症，尤其是糖尿病。体力活动计划是否能改善衰弱仍有待确定。
