Sarcopenia, Depression, and Chronic Inflammation, factors associated with Frailty in Older Adults on chronic hemodialysis in a hospital in the south of Chile

Abstract

Introduction: Chile has the highest prevalence of hemodialysis patients in South America, with 1260 patients per million inhabitants, 56% of whom are older adults. Currently, the prevalence of frailty in this group is unknown in Latin America. Objective: Determine the frailty of older adults on chronic hemodialysis at Angol Hospital and identify associated factors. Material and Methods: This is an observational, quantitative, and cross-sectional study, applying the FRAIL test as a diagnostic tool for frailty. Screening for depressive symptoms was carried out using the PHQ9 test, measurement of inflammatory status with the Malnutrition Inflammation Score (MIS), and evaluation of subjective quality of life with the Edmonton Symptom Assessment System Revised Renal (ESAS-r: Renal) test. In parallel, a Sarcopenia screening was carried out using bioimpedance following the criteria of the European Working Group on Sarcopenia in Older People. Results: 32 older adults on dialysis were evaluated. The prevalence of frailty was 25% (n=8). The presence of severe sarcopenia (p 0.00), history of falls in the last 6 months (p 0.00), elevated Parathyroid hormone levels (p 0.04), and poor performance on the Short Physical Performance Battery was associated with frailty (p 0.00), and elevated inflammation markers through the Malnutrition Inflammation Score (p 0.00). Frail patients scored higher in the subjective quality of life test Edmonton Symptom Assessment System- Renal (21, 8 vs. 47.5 p 0.00) and PHQ9 (7.5± 6.0 vs 3.8± 3.0 p: 0.01). Discussion: The prevalence was somewhat lower than the reported in the literature; however, phenotypically, it corresponds to a high-risk profile: sarcopenic, with a poor quality of life and marked by a pro-inflammatory microenvironment.