Frailty, physical function and affective status in elderly patients on hemodialysis

Objetives: To analyze depression, cognition, and physical function change in older adults on hemodialysis at 12-month follow-up, depending on frailty status. Design: Ongoing cohort study. Participants: 117 patients older than 69 years on hemodialysis; 75 men. Measurements: Frailty was measured with the frailty phenotype, disability in basic and instrumental activities of daily living with the Barthel and Lawton index respectively, physical function with the Short Physical Performance Battery (SPPB), cognitive status with the Mini Cognitive Examination, and depression with the Yesavage's Geriatric Depression Scale (GDS), at hemodialysis initiation and after 12-month follow-up. Inflammatory and nutrition profile was determined with C-reactive protein (CRP), albumin, and haemoglobin levels. Results: The mean age of the participants was 78.1 years; 63 (53.8 %) were frail. Frail participants had a higher 12-month mortality risk compared to the non frail ones, hazard ratio 2.6 (95 % CI 0.9-7.9). Frail 12-month survivors presented an improvement in median GDS scores (10 to 9; p = .009). There was no change in frail survivors from SPPB <= 6 to SPPB > 6 and a shift in 29.3 % of non-frail survivors from SPPB > 6 to SPPB <= 6 (p = .007) after 12-month follow-up. Median CRP and haemoglobin levels improved in frail 12-month survivors from 13.9 to 8.3 mg/dL (p = .019) and 9.9-11.1 g/dL (p < .001) respectively. Conclusions: Frail older adults that initiate hemodialysis present higher mortality than the non-frail ones at 12-month follow-up. Frail patients that survive improve physical function, depression and inflammatory profile compared to the non frail ones.