以质量求发展，以服务铸品牌

Journal of Nursing ›› 2018, Vol. 25 ›› Issue (20): 37-41.doi: 10.16460/j.issn1008-9969.2018.20.037

Previous Articles     Next Articles

Prevalence of Frailty in Patients with Maintenance Hemodialysis and Its Effect on Prognosis

DU Lan-yu1, HU Xia2, WANG Xiang-hong3, LIU Hai-na1, REN Lei1, ZHU Xiao-xiu1, DUAN You-ping1   

  1. 1. Blood Purification Center, The First People's Hospital of Zhumadian, Zhumadian 463000, China;
    2. Blood Purification Center, the Central Hospital of Zhumadian, Zhumadian 463000,China;
    3. Blood Purification Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
  • Received:2018-08-10 Published:2020-07-06

PDF (PC)

234

Like

Abstract: Objective To investigate the prevalence of frailty among maintenance hemodialysis (MHD) patients,and the effect of frailty on the prognosis. Methods A total of 425 MHD inpatients from two tertiary grade A hospitals between May 2010 and April 2013 was assessed using a frailty phenotype(FP). All of them were followed up for 5 years to observe the occurrence of all-cause mortality. Results (1) Clinical data of 380 patients were analyzed. The mean FP score was 2.33±1.53. The prevalence of frailty, pre-frailty and non-frailty were 44.2%, 42.1% and 13.7% respectively. The cumulative survival rate of 5 years in frailty, pre-frailty and non-frailty patients was 38.0%, 82.5% and 90.4% respectively（P<0.001）. (2) FP score was an independent predictor for 5-year survival rate in MHD inpatients after adjustment of age, albumin(ALB), C-reactive protein(CRP), Charlson comorbidity index(CCI) and estimated glomerular filtration rate(eGFR) （HR=1.311, P<0.001）. (3) The area under receiver operating characteristic (ROC) curves (AUC) of FP score which was used to predict the mortality of MHD patients for 5-year survival rate was 0.805, and when compared that with the random areas of 0.5, the difference was statistically significant (P<0.001). When the cut off value of FP score was 2.5 (Youden index was the biggest),the sensitivity,specificity and concordance rate were 0.757, 0.738 and 74.5%, respectively. Conclusion The prevalence of frailty in MHD patients is high. Frailty is an independent risk factor on the prognosis in MHD patients and FP score can provide valuable information for predicting the prognosis. It is suggested that frailty screening,assessment and intervention should be implemented in the management of MHD patients,which may improve the prognosis maximally.

Key words: maintenance hemodialysis, frailty, prognosis, management

CLC Number: 

  • R473.5
[1] Clegg A, Young J, IIiffe S, et al.Frailty in Elderly People[J].Lancet,2013,381(9868):752-762.DOI:10.1016/S0140-6736(12)62167-9.
[2] Morley J E, Vellas B, van Kan G A, et al.Frailty Consen-sus:A Call to Action[J]. J Am Med Dir Assoc,2013,14(6):392-397.DOI:10.1016/j.jamda.2013.03.022.
[3] Yadla M, John J P, Mummadi M.A Study of Clinical Assessment of Frailty in Patients on Maintenance Hemodialysis Supported by Cashless Government Scheme[J].Saudi J Kidney Dis Transpl,2017, 28(1):15-22.DOI:10.4103/1319-2442.198102.
[4] Yoneki K, Kitagawa J, Hoshi K, et al.Association between Frailty and Bone Loss in Patients Undergoing Maintenance Hemodialysis[J].J Bone Miner Metab,2018,15:1-9.DOI:10.1007/s00774-017-0898-4.
[5] Fried L P, Tangen C M, Walston J, et al.Frailty in Older Adults:Evidence for a Phenotype[J]. J Gerontol A Biol Sci Med Sci,2001,56(3):M146-156.
[6] Auyeung T W, Lee J S, Leung L, et al.The Selection of A Screening Test for Frailty Identification in Community-Dwelling Older Adults[J]. J Nutr Health Aging,2014,18(2):199-203.DOI:10.1007/s12603-013-0365-4.
[7] 奚兴,郭桂芳,孙静.社区老年人衰弱状况与抑郁症状关系的研究[J].护理学杂志,2014,29(15):87-92. DOI:10.3870/hlxzz.2014.15. 087.
[8] Li Y, Zou Y, Wang S, et al.A Pilot Study of the FRAIL Scale on Predicting Outcomes in Chinese Elderly People with Type 2 Diabetes[J]. J Am Med Dir Assoc,2015,16(8):714.DOI:10.1016/j.jamda.2015.05.019.
[9] 奚兴,郭桂芳.社区老年人衰弱现状及其影响因素研究[J].中国护理管理,2014,14(12):1315-1319. DOI:10.3969/j.issn.1672-1756.2014.12.024.
[10] 章婕,吴振云,方格,等.流调中心抑郁量表全国城市常模的建立[J].中国心理卫生杂志,2010, 24(2):139-143.DOI:10.3969/.J.issn.1000-6729.2010.02.015.
[11] 叶丽钦,张海林,周莹.血液透析患者衰弱的相关研究进展[J].中华护理杂志,2018,53(1):99-104.DOI:10.3761/j.issn.0254-1769.2018.01.018.
[12] Gustavaon A M, Falvey J R, Jankowski C M, et al.Public Health Impact of Frailty:Role of Physical Therapists[J]. J Frailty Aging,2017,6(1):2-5.DOI:10.14283/jfa.2017.1.
[13] Charlson M E, Pompei P, Ales K L, et al.A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies:Development and Validation[J]. J Chronic Dis,1987,40(5):373-383.
[14] Ma Y C, Zuo L, Chen J H, et al.Modified Glomerular Filtration Rate Estimating Equation for Chinese Patients with Chronic Kidney Disease[J]. J Am Soc Nephrol,2006,17(10):2937-2944.
[15] 竹琳,万正红,温怡,等.维持性血液透析患者衰弱的发生情况及其对跌倒的影响[J].现代临床护理, 2017, 16(11):9-13.DOI:10.3969/j.issn.1671-8283.2017.11.003.
[16] Kutner N G, Zhang R, Allman R M, et al.Correlates of ADL Difficulty in a Large Hemodialysis Cohort[J].Hemodial Int,2014,18(1):70-77.DOI:10.1111/hdi.12098.
[17] Bao Y, Dalrymple L, Chertow G M, et al.Frailty,Dialysis Initiation, and Mortality in End-Stage Renal Disease[J].Arch Intern Med,2012, 172(14):1071-1077.DOI:10.1001/archinternmed.2012.3020.
[18] Lee S Y, Yang D H, Hwang E, et al.The Prevalence,Association,and Clinical Outcomes of Frailty in Maintenance Dialysis Patients[J].J Ren Nutr,2017,27(2):106-112.DOI:10.1111/hdi.12098.
[19] 廖春霞,马红梅,徐旭,等.中国社区老年人衰弱发生率的Meta分析[J].职业与健康,2017,33(20):2767-2770.DOI:10.13329/j.cnki.zyyjk.2017.0829.
[20] 宋晓月,黄玲玲,张伟宏.郑州市社区老年人体质量指数与虚弱的相关性[J].中国康复理论与实践,2017,23(8):976-979.DOI:10.3969/j.issn.1006-9771.2017.08.022.
[21] Greenhall G H, Davenport A.Screening for Muscle Loss in Patients Established on Peritoneal Dialysis Using Bioimpedance[J].Eur J Clin Nutr,2017, 71(1):70-75.DOI:10.1038/ejcn.2016.202.
[22] Lee Y, Kim J, Han E S, et al.Frailty and Body Mass Index as Predictors of 3-Year Mortality in Older Adults Living in The Community[J].Gerontology,2014,60(6):475-482.DOI:10.1159/000362330.
[23] Johansen K L, Dalrymple L S, Delgado C, et al.Association between Body Composition and Frailty among Prevalent Hemodialysis Patients:A US Renal Data System Special Study[J].J Am Soc Nephrol,2014,25(2):381-389.DOI:10.1681/ASN.2013040431.
[24] Kutner N G, Zhang R, Huang Y, et al.Risk Factors for Frailty in A Large Prevalent Cohort of Hemodialysis Patients[J]. Am J Med Sci, 2014, 348(4):277-282.DOI:10.1097/MAJ.0000000000000250.
[25] Obi Y, Qader H, Kovesdy C P, et al.Latest Consensus and Update on Protein-Energy Wasting in Chronic Kidney Disease[J].Curr Opin Clin Nutr Metab Care,2015,18(3):254-262.DOI:10.1097/MCO.0000000000000171.
[26] 韩丹,杜晓莉,张银玲. 335例维持性血液透析患者乐观现状及影响因素分析[J].护理学报,2017,24(13):57-61.DOI:10.16460/j.issn1008-9969.2017.13.057.
[27] 范汝艳,张红梅,常立阳.太极拳运动对血液透析患者焦虑抑郁状态和睡眠质量的影响[J].中国血液净化,2016,15(4):241-243.DOI:10.3969/j.issn.1671-4091.2016.04.012.
[28] 马丽娜. 衰弱与老年人心血管病的关系[J].中华高血压杂志,2017, 25(4):384-387.DOI:10.16439/j.cnki.1673-7245.2017.04.018.
[29] 张璐,尤黎明,郑晶,等.体力活动水平对维持性血液透析患者死亡率的预测价值分析[J].护理学报, 2012, 19(9A):47-50.DOI:10.16460/j.issn1008-9969.2012.17.011.
[30] Johansen K L,Kaysen G A,Dalrymple L S,et al.Association of Physical Activity with Survival among Ambulatory Patients on Dialysis:The Comprehensive Dialysis Study[J].Clin J Am Soc Nephrol,2013, 8(2):248-253.DOI:10.2215/CJN.08560812.
[31] McAdams-DeMarco M A,Law A,Salter M L,et al. Frailty as a Novel Predictor of Mortality and Hospitalization in Individuals of All Ages Undergoing Hemodialysis[J]. J Am Geriatr Soc,2013,61(6):896-901.DOI:10.1111/jgs.12266.
[32] 王燕秋,韩斌如.衰弱表型定义对老年人不良结局预警的研究进展[J].护理学报,2015,22(14):20-23.DOI:10.16460/j.issn1008-9969.2015.14.020.
[33] Sampaio L S, Carneiro J A, Coqueiro R D,et al.Anthropometric Indicators as Predictors in Determining Frailty in Elderly People[J]. Cien saude colet, 2017, 22(12):4115-4124.DOI:10.1590/1413-812320172212.05522016.
[34] 童赟,林泽文,李英文,等.自我效能训练对维持性血液透析患者营养状况的影响[J].护理学报,2015,22(20):47-49.DOI:10.16460/j.issn1008-9969.2015.20.047.
[35] Sezer S, Bal Z, Tutal E, et al.Long-term Oral Nutrition Supplementation Improves Outcomes in Malnourished Patients with Chronic Kidney Disease on Hemodialysis[J].JPEN J Parenter Enteral Nutr, 2014, 38(8):960-965.DOI:10.1177/0148607113517266.
[36] 郭青,赵荻,贺碧英,等.血液透析患者透析相关性疲乏非药物性干预研究进展[J].护理学报,2015,22(11):33-36.DOI:10.16460/j.issn1008-9969.2015.11.036.
[1] LI Jiang-wei, WANG Shu-jun, LI Chang-zai, HU Bao-shan, JIAO Gui-mei, ZHANG Wei-hong. Effects of nursing intervention based on stress and coping theory on psychological stress, negative emotions and self-management in patients with permanent enterostomy after surgery for colorectal cancer [J]. Journal of Nursing, 2025, 32(4): 64-69.
[2] MA Xiao-lan, XU Wei-fang. Application effect of ice water spray based on symptom management theory in thirsty patients undergoing thoracoscopic lobectomy [J]. Journal of Nursing, 2025, 32(4): 70-73.
[3] WU Chao-yu, LIU Shang-kun. Crisis management competence of nurses in post-anesthesia care unit: a qualitative study [J]. Journal of Nursing, 2025, 32(3): 17-21.
[4] LI Ruo-Yu, LIU Xin, LIN Ping, CHEN Dan, LIN Hua. Best evidence summary for medication safety management for discharged patients [J]. Journal of Nursing, 2025, 32(3): 50-55.
[5] YANG Bei, YE Hong-fang, ZHANG Ning, XIANG Lu-wei, LU Shi-yu. Current status of physical activity and its influencing factors in elderly patients with type 2 diabetes [J]. Journal of Nursing, 2025, 32(2): 7-12.
[6] ZHU Tian-shun, ZHU Ke-ke, XUE Hui-yuan, JIAO Cong-cong, WEI Chang-hui, WANG He. Application of message framing theory in health management: a scoping review [J]. Journal of Nursing, 2025, 32(2): 44-49.
[7] LIU Shuo-yi, XIONG Li-juan, LI Ling, WANG Yu-mei, HE Jia, LI Xin, YUAN Shi-lei, GUO Xue-qin, WANG Yang-jing, ZHANG Hui-juan. Quality evaluation and content analysis of clinical practice guidelines for prevention and management of frailty in elderly hospitalized patients [J]. Journal of Nursing, 2025, 32(2): 50-55.
[8] YAN Ya-ling, LE Mei-ni, YAO Tao-qin, WANG Xue-lian, JIANG Jian-ling, XIN Yi. Construction of perioperative frailty management program for elderly patients with gastrointestinal tumors [J]. Journal of Nursing, 2025, 32(2): 74-78.
[9] WEN Min, CHEN Bing, ZHOU Yong-ling, LIU Juan, ZHU Xiao-dan. Construction of joint intervention program of cognitive remediation based on mobile health APP for schizophrenia patients [J]. Journal of Nursing, 2024, 31(9): 1-4.
[10] YE Xiang, LI Kai, HUANG Min, ZHANG Qian, LI Ji-min, LIU Rong-zhen, MENG Min, ZHU Shao-yu, XIE Cui-hua. Mobile APP plus family management of blood glucose for adult patients with type 2 diabetes [J]. Journal of Nursing, 2024, 31(9): 60-65.
[11] ZHENG Tao-hua, GAO Xiang, KANG Mei, WEI Hai-xia, LIU Xiao, ZHANG Li. Application of 4R Crisis Management Theory in risk management of hypoglycemia during peri-colonoscopy period [J]. Journal of Nursing, 2024, 31(7): 22-26.
[12] NI Le-feng, LIU Lin, SHEN Chun-hua, QIAO Yao, ZHOU Liang, ZHU Qiang, GONG Wei-juan. Quality evaluation and content analysis of guidelines for time limit management in transfusion nursing [J]. Journal of Nursing, 2024, 31(7): 51-56.
[13] XUE Rong, ZHANG Kai-li, CHEN Bao-yun, MA Rong-hui, ZHANG Yu-xin. Multidimensional frailty development trajectory and its influencing factors in middle-aged and elderly stroke patients [J]. Journal of Nursing, 2024, 31(6): 6-12.
[14] LI Ai-qun, LI Li-hua, WANG Fang, JIANG Yuan-yuan, CAI Yi-min. Mediating effects of chronic disease resource utilization between self-transcendence and self-management behaviors in coronary artery disease patients after PCI [J]. Journal of Nursing, 2024, 31(6): 13-17.
[15] CHEN Fang, YANG Min-fei, YAO Xiao-yue, ZHOU Shi-bo. Construction and practice of intra-hospital nursing security system in designated hospitals for Hangzhou Asian Games [J]. Journal of Nursing, 2024, 31(6): 35-38.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!