title: A study of clinical assessment of frailty in patients on maintenance hemodialysis supported by cashless government scheme.
abstract: This is a prospective cohort study to assess the prevalence of frailty in patients undergoing maintenance hemodialysis (HD) under the government-funded scheme at our center and to assess the relationship between frailty and falls, hospitalizations, and mortality. This was done at our center which is completely supported by the government, which provides HD to all the patients under poverty line. Epidemiological data, anthropometric measurements, comorbidities assessment, frailty assessment using Fried criteria, subsequent hospitalizations, falls, and mortality were recorded in our prevalent dialysis population at our center between October 2014 and October 2015. Two hundred and twenty-six patients were enrolled during this period. Twenty-one patients were excluded as they did not satisfy the inclusion criteria. Two hundred and five prospective patients were studied for the predictors of frailty. Frailty was present in 82% of the study population. Mean age of our study population was 44.95 ± 13.27 years. On univariate analysis, diabetes mellitus, hypertension (HTN), cerebrovascular accident (CVA), left ventricular dysfunction (LVD), peripheral vascular disease (PVD), smoking, hepatitis C, inadequate dialysis, intradialytic hypotension (IDH), interdialytic weight gain, low serum creatinine <4 mg/dL, and anemia (Hb <10 g/dL) were found to be statistically significantly different between frail and nonfrail groups On multivariate regression analysis, only HTN, PVD, CVA, anemia, smoking, and IDH were found to be significant. Frailty is highly prevalent among dialysis population. Factors predicting frailty include HTN, smoking, LVD, PVD, CVA, smoking, anemia, and IDH. Frailty is a significant risk factor for falls and hospitalizations.
authors.affiliation: Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India.
authors.forename: Manjusha
authors.initials: M
authors.lastname: Yadla
authors.affiliation: Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India.
authors.forename: Jyothi Priyadarshini
authors.initials: JP
authors.lastname: John
authors.affiliation: Department of Epidemiology and Statistics, Community Medicine, Gandhi Medical College, Hyderabad, Telangana, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Mummadi
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000328:Adult; D015897:Comorbidity; D005260:Female; D000073496:Frailty / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006304:Health Status; D006801:Humans; D007194:India / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008483:Medical Assistance; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome