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Arias-Guillén M, Romano B, Yuguero-Ortiz A, López-Lazcano A, Guerrero S, Villegas V, Martínez M, Clemente N, Gómez M, Rodas L, Broseta JJ, Quintela M, Maduell F, Bayés B. Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions. Clin Kidney J 2023; 16:2174-2184. [PMID: 37915889 PMCID: PMC10616445 DOI: 10.1093/ckj/sfad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 11/03/2023] Open
Abstract
Background The number of frail patients of advanced age with end-stage kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score, protein-energy wasting), physical [short physical performance battery (SPPB)] and psychological status. Results A total of 167 patients (mean ± standard deviation age 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (P = .025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped in advising patients on individual nutritional, physical or psychological needs.
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Affiliation(s)
- Marta Arias-Guillén
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Bárbara Romano
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain
| | - Anna Yuguero-Ortiz
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, Barcelona, Spain
| | - Ana López-Lazcano
- Clinical Health Psychology Section, Psychiatry and Clinical Psychology Service, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
| | - Sonia Guerrero
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Vanesa Villegas
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Mar Martínez
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Nuria Clemente
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Miquel Gómez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació Clínic per la Recerca Biomèdica (FCRB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - José Jesús Broseta
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Marta Quintela
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Francisco Maduell
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Beatriu Bayés
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
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Yuguero-Ortiz A, Gomez M, Arias-Guillén M, Ojeda R, Fontseré N, Rodas L, Jesús Broseta J, Vera M, Hernandez-Sanchez S, Maduell F. Impact and safety outcomes of an intradialytic physical exercise program. Nefrologia 2021; 41:556-565. [PMID: 36165138 DOI: 10.1016/j.nefroe.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. OBJECTIVES We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients. MATERIAL AND METHODS This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded. RESULTS The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47 m; p < 0.001), superior limbs (HG average increase of 1.6 kg; p = 0.007) as well as the lower extremities (10STS; p = 0.003; dynamometry p < 0.05). Regarding safeness, there were no incidences neither significant difference in the RBV. CONCLUSIONS A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.
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Affiliation(s)
- Anna Yuguero-Ortiz
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Miquel Gomez
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Arias-Guillén
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Raquel Ojeda
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Néstor Fontseré
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - José Jesús Broseta
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manel Vera
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sonsoles Hernandez-Sanchez
- Department of Physical and Sports Education, School of Sports Science, PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Francisco Maduell
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
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Yuguero-Ortiz A, Gomez M, Arias-Guillén M, Ojeda R, Fontseré N, Rodas L, Broseta JJ, Vera M, Hernandez-Sanchez S, Maduell F. Impact and safety outcomes of an intradialytic physical exercise program. Nefrologia 2021. [PMID: 33888350 DOI: 10.1016/j.nefro.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. OBJECTIVES We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients. MATERIAL AND METHODS This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded. RESULTS The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47m; p<0.001), superior limbs (HG average increase of 1.6kg; p=0.007) as well as the lower extremities (10STS; p=0.003; dynamometry p<0.05). Regarding safeness, there were no incidences neither significant difference in the RBV. CONCLUSIONS A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.
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Affiliation(s)
- Anna Yuguero-Ortiz
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España.
| | - Miquel Gomez
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Arias-Guillén
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Raquel Ojeda
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Néstor Fontseré
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Lida Rodas
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - José Jesús Broseta
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Manel Vera
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Sonsoles Hernandez-Sanchez
- Department of Physical and Sports Education, School of Sports Science, PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), University of Granada, Granada, España; Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, España
| | - Francisco Maduell
- Diàlisi i Recerca Aplicada Clínic (DIRAC), Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
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