Abstract

Background and Aims

Frailty is known as a biological syndrome of decreased reserves and resistance to stress, with a decline of multiple physiological systems, causing vulnerability. Its prevalence ranges from 10-80 %. The etiopathogenesis is multifactorial, based on the loss of muscle mass associated with aging or sarcopenia. Chronic Kidney Disease (CKD) is a model of accelerated aging, with impaired physical function, frailty and cognitive decline.

The main theorical frameworks on frailty are the one advocated by Linda Fried, in which she develops a phenotype as a risk situation for developing disability and one advocated by Kennet Rockwood which establishes that frailty consists of addition of various health conditions including comorbidity and disability. Our objective was to evaluate frailty in stage 5 CKD in haemodialysis, measured by clinical scale and to relate it to the body composition measured by bioimpedance.

Method

Cross-sectional study in 40 subjects with CKD in hospital haemodialysis, 70.5±13.03 years, 62.5% male. 40% Diabetic Nephropathy, 10% Glomerulopathies, 7.5% Nephroangiosclerosis, 2.5% Chronic Tubule-Interstitial Nephropathies, 32.5% Unknow, 2.5% Others. 35% arteriovenous fistula, 10% arteriovenous graft, 55% central venous catheter. Hemodialysis type: 40% High Flux, 45% Online postdilutional Haemodiafiltration, 10% Acetate Free Biofiltration. Fragility was measured by the Rockwood clinical scale: not fragile (1-4), moderately fragile (5-6) and severely fragile (7-9). Body composition was estimated by monofrequency bioimpedance measurement. Chi-Cuadrado was used to study differences between dichotomous variables and ANOVA for continuous variables. Spearman correlation´s was used to examinate the intensity of association between two quantitative variables. Statistical analysis was performed with SPSS 13.0.

Results

42.5% of the subjects presented a degree of fragility ≥5, severely fragile 27.5%.

The results are shown in the Tables 1 and 2.

r s Sig.
Phase angle -0.59 0.0001
Exchange Na/K 0.3 0.06
Total body water -0.43 0.0059
EW 0.59 0.0001
IW -0.59 0.0001
EW/IW 0.59 0.0000
FFM -0.52 0.0007
MM -0.72 0.0000
FM 0.22 0.17
BCMI -0.63 0.0000
r s Sig.
Phase angle -0.59 0.0001
Exchange Na/K 0.3 0.06
Total body water -0.43 0.0059
EW 0.59 0.0001
IW -0.59 0.0001
EW/IW 0.59 0.0000
FFM -0.52 0.0007
MM -0.72 0.0000
FM 0.22 0.17
BCMI -0.63 0.0000
r s Sig.
Phase angle -0.59 0.0001
Exchange Na/K 0.3 0.06
Total body water -0.43 0.0059
EW 0.59 0.0001
IW -0.59 0.0001
EW/IW 0.59 0.0000
FFM -0.52 0.0007
MM -0.72 0.0000
FM 0.22 0.17
BCMI -0.63 0.0000
r s Sig.
Phase angle -0.59 0.0001
Exchange Na/K 0.3 0.06
Total body water -0.43 0.0059
EW 0.59 0.0001
IW -0.59 0.0001
EW/IW 0.59 0.0000
FFM -0.52 0.0007
MM -0.72 0.0000
FM 0.22 0.17
BCMI -0.63 0.0000
Conclusion

The degree of frailty is greater in the elderly. Measurement of body composition by bioimpedance can be useful to indirectly asses frailty. The phase angle could be an indicator of fragility, since in more fragile subjects its value decreases, its physiological role remains to be elucidated. There is a positive trend to an increase in extracellular water in more fragile subjects, keeping the subjects in their dry weight, so it will be necessary to evaluate what is due.

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