SP716IS FRAILTY ASSOCIATED WITH QUALITY OF LIFE, NUTRITIONAL STATUS AND CLINICAL CONDITION IN ELDERLY PATIENTS ON HEMODIALYSIS?

and Aims:We aimed to examine the association between frailty and quality of life (QOL), nutritional status and clinical condition in elderly patients on hemodialysis (HD). Methods: Observational and cross-sectional study including 157 non institutionalized patients aged >60 years on HD for at least 3 months. The QOL was assessed by the Kidney Disease and Quality of Life questionnaire (KDQOL), nutritional status was assessed by the subjective global assessment (SGA), body fat (BF; by skinfold thicknesses) and skeletal muscle mass (SMM; by bioelectrical impedance). BF and SMM were divided by the square height in meters to calculate the BF index and SMM index. The clinical condition was assessed by urea Kt/V, albumin, 25 OH Vitamin D and C-reactive protein (CRP). Frailty was defined by a modification of the 5 frailty criteria from Fried et al: 1. Weight loss: Unintentional weight loss ≥2.5 kg in the past 6 months; 2. Slow walking: scored when answering “yes, limited a lot” for the question: “How much your health now limits you to walk one block?”; 3. Weakness: Handgrip strength (measured by hand dynamometer) in the lowest 20% percentile of our sample according to gender (≤20kg for men and ≤14kg for women); 4. Exhaustion: scored when answering “Some of the time”, “ a good bit of the time”, “most of the time” or “all of the time” for the question “How much of the time during the past 4 weeks did you feel worn out?”; 5. Low physical activity: defined from self-reported exercise habits. Three groups were created based on the number of positive frailty criteria: 3 to 5 domains: Frailty group (FrailG); 1 to 2 domains: Pre-frailty group (PreFG); No domain: Non-frailty group (Non-FG). Results: The prevalence of frailty, prefrail and non-frail was 31% (n=48), 62% (n=97) and 8% (n=12), respectively. The mean age was similar among the groups (FrailG=72 ±8; PreFG=70±7; Non-FG=73±8 years). The proportion of women was higher in the FrailG (FrailG=63%; PreFG=24%; Non-FG=25%, p<0.001). Regarding QOL, among the 22 domains of KDQOL, 18 were significant lower in the FrailG (p<0.05). Regarding the nutritional status, protein energy wasting (assessed by SGA) was higher in the FrailG than in the PreFG and Non-FG (72%; 56% and 33%; P=0.03, respectively). A tendency toward higher BF index was observed in the FrailG (FrailG=9.3±3; PreFG= 7.9±3; Non-FG=7.7±3; p=0.07) and no difference was observed for the SMM index (FrailG=8.1±2; PreFG=8.7±2; Non-FG=9.1±2 kg/m2; P=0.11). Regarding the clinic condition, CRP was higher in the FrailG (0.37 (25th-75th, 0.2-1.2mg/dl) and PreFG 0.51 (25th-75th, 0.2-1.1mg/dl) than in the Non-FG (0.20 (25th-75th, 0.1-0.5mg/dl); P=0.04). Frailty score was negatively associated with SGA scores (r=-0.35; P<0.01); and SMM index (r=-0.3; P<0.01) and positively associated with BF index (r=0.20; P=0.02). In addition, frailty criteria was negatively associated with 19 from 22 KDQOL domains. Conclusions: In conclusion, in elderly on HD frailty was associated with worse QQL and nutritional status. The inflammatory status was worse in the Frail and Pre-frail groups.