A Clinical Study of Comparison of Frail Diabetes vs Frail Nondiabetes Groups and Correlation with Outcomes in Patients on Maintenance Hemodialysis

Special Article - Hemodialysis

Austin J Nephrol Hypertens.2017; 4(2): 1070.

A Clinical Study of Comparison of Frail Diabetes vs Frail Nondiabetes Groups and Correlation with Outcomes in Patients on Maintenance Hemodialysis

Manjusha Yadla* and Jyothi Priyadarshini

Department of Nephrology, Gandhi Medical College, India

*Corresponding author: Manjusha Yadla, Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India

Received: July 16, 2017; Accepted: August 08, 2017; Published: August 28, 2017

Abstract

Aim: To compare frail diabetes group with frail nondiabetes group and correlation with outcomes in patients on maintenance hemodialysis.

Patients and Methods: We assessed frailty in patients on maintenance hemodialysis in our centre over a period of one year. Patients with diabetes kidney disease (frail diabetes group) and the end stage renal disease patients with nondiabetic kidney disease (frail nondiabetes group) were studied for the outcomes like falls, hospitalizations and deaths.

Results: A total of 205 patients were on maintenance hemodialysis in our centre. Of this, 167 patients satisfied the inclusion and exclusion criteria and were included in the study. Of 167 patients, 108 patients had diabetic renal disease and 59 patients had non diabetic kidney cause. Factors associated with frailty were identified to be presence of hypertension, presence of peripheral vascular disease, smoking, hepatitis C, low Kt/V, anemia, serum creatinine, higher inter dialytic weight gain and presence of intra dialytic hypotension. Outcomes like falls and hospitalizations were more in frail diabetes compared to frail nondiabetes group.

Conclusion: Prevalence of frailty is high in patients with diabetes related end stage renal disease on dialysis than in patients with non diabetes related kidney disease.

Falls and hospitalizations are more in patients of frail diabetes group compared to nonfrail diabetes group though there was no difference in deaths between the two groups.

Keywords: Frailty; Diabetes mellitus; Maintenance; Hemodialysis

Introduction

Frailty is a state of decreased physical reserves causing loss of physical and mental strengths [1]. Frailty is reported to be a state of improper, premature and unsuccessful ageing. Frailty is known to be severe in patients with chronic illnesses like diabetes, chronic kidney disease. It is also understood that with increasing severity of kidney disease, frailty would increase in severity because CKD is a state of chronic inflammation.

Diabetes mellitus is a multisystem disease with progressive loss of structure and function of the organs involved. With the increasing longevity of survival, the ageing population would be on rise in future. The incidence of diabetes is also expected to rise to by 2025. Immunologically, diabetes is state of chronic low grade inflammation. Diabetes is reported to be associated with accelerated ageing which causes sarcopenia and thus increased frailty. Hence diabetes is said to an immunoageing process. Though the pathogenesis of frailty is multifactorial in patients with diabetes, presence of sarcopenia would lead to hyperglycemia due to inadequate metabolism [2]. Presence of hyperglycemia and sarcopenia are interdependent and hence in patients with diabetes, frailty may be severe. It is expected that both the diabetes and end stage renal disease being chronic inflammatory states associated with sarcopenia, frailty would be severe in both the conditions.

Presence of diabetes may be considered as a risk factor for development of frailty in patients on maintenance hemodialysis. In addition, certain preventive measures may be taken to reduce the morbidities like falls, hospitalizations

Aim

To determine the impact of diabetes on frailty in patients on maintenance hemodialysis.

Patients and Methods

The study was carried out at our centre in 210 patients. Under this cashless government scheme, Patients are given thrice weekly hemodialysis using polysulfone membrane with surface area of 1.3 m2. Total number of hours of hemodialysis per week was 12 hours per patient. Erythropoietin is given twice weekly depending on the requirement. All the patients had permanent vascular access. Daily clinical assessment and a periodical biochemical assessment is done as per the scheme which is funded by the government for the below poverty line patients.

Inclusion criteria

Patients who have been on regular dialysis schedule for at least 6 months

Patients of >18 years of age and <65 years

Patients who have given consent to participate in the study

Those who are frail by Fried frailty criteria

Exclusion criteria

Patients of <18 years and >65 years.

Patients who are bed ridden, had a recent history of hospitalization, psychological illness.

Patients who have not given consent.

Patients are divided into two groups, those with diabetes and frailty –frail diabetes group and those with frailty, but without diabetes –frail nondiabetes group.

Demographic data, details of dialysis, lab parameters and the outcomes like falls, hospitalizations and deaths were assessed.

Results

A total of 205 patients were on hemodialysis in our centre. 167 patient’s satisfied inclusion and exclusion criteria. Of this, 108 patients had diabetes related end stage renal disease and 57 had renal disease due to other causes.

Baseline characteristics of both the groups are shown in Table 1. Prevalence of frailty in our population was 81.46%. Number of patients in frail diabetes group was 108 (64%) and in frail nondiabetes group was 57 (35%). Male to female ratio was 112:55. The number of patients of age >40 years (98) were more than those with age <40 years (69). There was no statistically significant difference in age, gender, BMI, vintage of dialysis, type of vascular access between both the groups. Factors like hypertension, peripheral vascular disease, smoking, lowers Kt/V, anemia, higher inter dialytic weight gain and presence of intradialytic hypotension.