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Title: Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services
Authors: García Cantón, César 
Rodenas, Ana
Lopez-Aperador, Celia
Rivero, Yaiza
Anton, Gloria
Monzon, Tania
Diaz, Noa
Vega Díaz, Nicanor Jesús 
Loro Ferrer, Juan Francisco 
Santana del Pino, Ángelo 
Esparza, Noemi
UNESCO Clasification: 320506 Nefrología
Keywords: Frailty
Issue Date: 2019
Journal: Renal Failure 
Abstract: Background: Frailty is an aging-associated state of increased vulnerability, which raises the risk of adverse outcomes. Chronic kidney disease is associated with higher prevalence of frailty. Our aim was to estimate frailty prevalence in a hemodialysis population and its influence on short-term outcomes. Design: Observational prospective longitudinal study of 277 prevalent hemodialysis patients. Frailty was estimated through the Edmonton Frail Scale (EFS). Demographic and clinical data, comorbidity index, and laboratory parameters were recorded. A 29-month follow-up was conducted on mortality, including hospitalization, and visits to hospital emergency services in the first 12 months of this period. Results: According to the EFS, 82 patients (29.6%) were frail, 53 (19.1%) were vulnerable, and 142 (51.3%) were non-frail. During follow-up, 58.5% frail patients, 30.2% vulnerable, and 16.2% non-frail ones died (p <.005). In the analysis of survival using an adjusted Cox model, a higher hazard of mortality was observed in frail than in non-frail patients (HR 2.34; 95% CI 1.39–3.95; p =.001). During follow-up the hospitalization rate was 852 episodes/1000 patient-years for frail patients, 784 episodes/1000 patient-years for vulnerable patients, and 417 episodes/1000 patient-years for non-frail patients (p =.0005). The incidence ratio of visits to emergency services was 3216, 1735, and 1545 visits/1000 patient-years for each group (p <.001). Conclusions: Hemodialysis patients present high frailty prevalence. Frailty is associated with poor short-term outcomes and higher rates of mortality, visits to hospital emergency services, and hospitalization.
ISSN: 0886-022X
DOI: 10.1080/0886022X.2019.1628061
Source: Renal Failure [ISSN 0886-022X], v. 41 (1), p. 567-575
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