Beyond sarcopenia: frailty in chronic haemodialysis patients

Abstract

Background Frailty, characterized by vulnerability, reduced reserves, and increased susceptibility to severe events, is a significant concern in chronic hemodialysis (CHD) patients. Sarcopenia, corresponding to the progressive loss of muscle mass and strength, may contribute to frailty by reducing functional capacity, mobility, and autonomy. However, consensus lacks on optimal frailty bedside index for CHD patients. This study investigated the influence of frailty on CHD patient survival and explored the associated factors. Methods One hundred and thirty-five patients were enrolled from January to April 2019 and then followed up prospectively until April 2022. At inclusion, frailty was assessed by Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests including gait speed, standing balance and lower limb muscle strength. Results From a total of 114 prevalent CHD patients [66% men, age 67.6+/−15.1 years], 30 died during the follow-up period of 23.7 (16.8–34.3) months. Deceased patients were older, had more comorbidities and a higher sarcopenia prevalence (P < 0.05). The TUG test and SPPB scores were significantly reduced in deceased patients [SPPB Total score: 7.2+/−3.3 vs 9.4+/−2.5; TUG time (8.7+/−5.8 vs 13.8+/−10.5 (P < 0.05)]. Multivariate analysis showed that a higher SPPB score (total value > 9) was associated with a lower mortality risk (HR = 0.83, 95% CI 0.74–0.92; P < 0.03). Each component of the SPPB test was also associated with mortality in univariate analysis but only the SPPB balance test remained protective against mortality in multivariate analysis. Higher age, lower handgrip strength and lower protein catabolic rate were associated with SPPB total scores < 9, SPPB balance score and TUG time >10 sec. Conclusions Screening for frailty is crucial in CHD patients, and incorporating SPPB, especially the balance test, provides valuable insights. Diminished muscle strength and inadequate protein intake negatively influence SPPB score and balance in CHD patients. An effective identification and management of frailty can therefore improve outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03845452.