GENÇ ERİŞKİN HEMODİYALİZ HASTALARINDA KIRILGANLIK VE KOGNİTİF BOZUKLUK ARASINDAKİ İLİŞKİ

Abstract

Amaç: Kırılganlık; geriyatrik popülasyonlarda oluşturulmuş, fiziksel inaktiviteyi ve hastalık komplikasyonlarına duyarlılığı anlatan bir tanımlamadır. Hemodiyaliz (HD) hastalarında kırılganlığı inceleyen çalışmaların çoğu yaşlı popülasyonlardadır. Kognitif bozukluk HD hastalarının göz ardı edilen bir sorunudur. Bu çalışmanın amacı genç erişkin HD hastalarında kırılganlıkla kognitif bozukluk arasındaki ilişkiyi araştırmaktır. Yöntemler: Çalışmaya 18-65 yaş arası 102 HD hastası alındı. Kırılganlık; klinik kırılganlık indeksi (KKİ) ile, kognitif durum Montreal Cognitive Assesment (MoCA) ile değerlendirildi. KKİ puanı 5-7 arası olan hastalar kırılgan, 4-7 arası olanlar duyarlı-veya-kırılgan olarak belirlendi. MoCA skoru <24/30 olanlar kognitif bozukluk olarak değerlendirildi. Bulgular: Hastaların yaş ortalaması 48,3±12,4 yıl idi. Duyarlı-veya-kırılgan olma %26,7, kırılganlık %12,7 sıklıkta bulundu. Kognitif bozukluk sıklığı %69,6 idi. Kognitif bozukluğu olan ve olmayan HD hastaları karşılaştırıldığında, kognitif bozukluğu olanlarda hem kırılgan olma sıklığı hem de duyalı-veya-kırılgan olma sıklığı anlamlı düzeyde artmıştı (sırasıyla %22,4; %0,0 p=0,011 ve %57,7; %3,3 p<0,001). KKİ puanı ile MoCA skoru arasında anlamlı negatif korelasyon vardı (-r=0,607, p<0,001). Bu korelasyon yaş, diyabetes mellitus ve kardiyovasküler hastalıkla yapılan regresyon analizinden sonra anlamlılığını korudu (p=0,012). Sonuç: Bu çalışma genç erişkin HD hastalarında kırılganlığın kognitif bozukluk ile ilişkili olabileceğini gösterdi. HD hastalarında kırılganlığın belirlenmesi, inaktivite ve komorbiditeler dışında, kognitif bozukluğa karşı da önlem almamızı gerektirebilir.

Keywords

• Kırılganlık,kognitif bozukluk,hemodiyaliz

THE RELATIONSHIP BETWEEN FRAILTY AND COGNITIVE IMPAIRMENT IN YOUNG ADULT HEMODIALYSIS PATIENTS

Abstract

Objective: Frailty is a definition used in relation to geriatric populations, indicating physical inactivity and susceptibility to disease. Studies investigating frailty in hemodialysis (HD) patients mostly include the elderly. Cognitive impairment is overlooked in HD patients. This study aims to investigate associations between frailty and cognitive impairment in young-adult HD patients. Methods: The study included 102 HD patients aged 18-65 years old. Frailty was evaluated using the clinical frailty index (CFI) and cognition was evaluated using the Montreal Cognitive Assessment (MoCA). A CFI value between 5 and 7 was defined as frail, and 4-7 was defined as vulnerable-or-frail. An MoCA value <24/30 was determined as cognitive impairment. Results: Mean patient age was 48.3±12.4 years. Vulnerable-or-frail patients accounted for 26.7%, frailty, 12.7%. Frequency of cognitive impairment was 69.6%. The likelihood of Frailty and being vulnerable-or-frail were increased in patients with cognitive impairment compared with those without cognitive impairment (22.4%; 0.0% p=0,011 and 57.7%; 3,3% p<0,001). CFI and MoCA were negatively correlated (-r=0,607, p<0.001), which was still significant after adjusting for age, diabetes mellitus and cardiovascular disease (p=0.012). Conclusion: This study showed that frailty may be associated with cognitive impairment in young-adult HD patients. Determining frail HD patients may necessitate dealing with inactivity, comorbidities and also cognitive impairment.

Keywords

• Frailty,cognitive impairment,hemodialysis

References

1. 1. Seliger SL. Frailty and Cognitive Impairment in ESRD: Brain-Body Connections. Clin J Am Soc Nephrol 2015; 10(12):2104-2106.
2. 2. Iyasere O, Okai D, Brown E. Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making. Clin Kidney J 2017;10(1):89-94.
3. 3. Johansen KL, Delgado C, Bao Y, Kurella Tamura M. Frailty and dialysis initiation. Semin Dial 2013;26(6):690-6.
4. 4. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):146-56.
5. 5. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14(6):392-7.
6. 6. Musso CG, Jauregui JR, Macías Nú-ez JF. Frailty phenotype and chronic kidney disease: a review of the literature. Int Urol Nephrol 2015;47(11):1801-7.
7. 7. Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: A systematic review. Arch Gerontol Geriatr 2017;68:135-42.
8. 8. McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, Walston JD, Segev DL. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc 2013;61(6):896-901.

9. 9. Kurella Tamura M, Larive B, Unruh ML, Stokes JB, Nissenson A, Mehta RL, Chertow GM; Frequent Hemodialysis Network Trial Group. Prevalence and correlates of cognitive impairment in hemodialysis patients: the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol. 2010; 5(8):1429-38.
10. 10. National Kidney Foundation Hemodialysis Adequecy 2015 Work Group. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis 2015;66(5):884-930.
11. 11. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173(5):48995.
12. 12. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53(4):695-9.
13. 13. Tholen S, Schmaderer C, Kusmenkov E, Chmielewski S, Förstl H, et al. Variability of cognitive performance during hemodialysis: standardization of cognitive assessment. Dement Geriatr Cogn Disord 2014;38(1-2):31-8.
14. 14. Angermann S, Baumann M, Steubl D, Lorenz G, Hauser C, et al. Cognitive impairment in hemodialysis patients: Implementation of cut-off values for the Montreal Cognitive Assessment (MoCA)-test for feasible screening. PLoS One 2017;12(10):e0184589.
15. 15. Tiffin-Richards FE, Costa AS, Holschbach B, Frank RD, Vassiliadou A, Krüger T, et al. The Montreal Cognitive Assessment (MoCA) - a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients. PLoS One 2014;9(10):e106700.
16. 16. Erken E, Ozelsancak R, Sahin S, Yılmaz EE, Torun D, Leblebici B, Kuyucu YE, Sezer S. The effect of hemodialysis on balance measurements and risk of fall. Int Urol Nephrol 2016;48(10):1705-11.
17. 17. Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 2017;17(4):529-44.
18. 18. Roshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel KV, de Boer IH, et al. A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis 2012;60(6):912-21.
19. 19. McAdams-DeMarco MA, Tan J, Salter ML, Gross A, Meoni LA, Jaar BG, Kao et al. Frailty and Cognitive Function in Incident Hemodialysis Patients. Clin J Am Soc Nephrol 2015;10(12):2181-9.
20. 20. Bao Y, Dalrymple L, Chertow GM, Kaysen GA, Johansen KL. Frailty, dialysis initiation, and mortality in end-stage renal disease. Arch Intern Med 2012;172(14):1071-7.
21. 21. Iyasere OU, Brown EA, Johansson L, Huson L, Smee J, Maxwell AP, Farrington K, Davenport A. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis. Clin J Am Soc Nephrol 2016;11(3):423-30.
22. 22. Alfaadhel TA, Soroka SD, Kiberd BA, Landry D, Moorhouse P, Tennankore KK. Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol 2015;10(5):832-40. doi: 10.2215/CJN.07760814.
23. 23. Kallenberg MH, Kleinveld HA, Dekker FW, van Munster BC, Rabelink TJ, van Buren M, Mooijaart SP. Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD-A Systematic Review. Clin J Am Soc Nephrol 2016;11(9):1624-39.
24. 24. Kutner NG, Zhang R, Huang Y, McClellan WM, Soltow QA, Lea J. Risk factors for frailty in a large prevalent cohort of hemodialysis patients. Am J Med Sci 2014;348(4):277-82.
25. 25. Nakatani T, Naganuma T, Uchida J, Masuda C, Wada S, Sugimura T, Sugimura K. Silent cerebral infarction in hemodialysis patients. Am J Nephrol 2003;23(2):86-90.
26. 26. Hirani V, Naganathan V, Blyth F, Le Couteur DG, Kelly P, Handelsman DJ, Waite LM, Cumming RG. Cross-Sectional and Longitudinal Associations Between Anemia and Frailty in Older Australian Men: The Concord Health and Aging in Men Project. J Am Med Dir Assoc 2015;16(7):614-20.
27. 27. Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol 2011;6(2):24856.
28. 28. Tajar A, Lee DM, Pye SR, O’Connell MD, Ravindrarajah R, Gielen E, et al. The association of frailty with serum 25-hydroxyvitamin D and parathyroid hormone levels in older European men. Age Ageing 2013;42(3):352-9.
29. 29. Bonanni A, Mannucci I, Verzola D, Sofia A, Saffioti S, Gianetta E, Garibotto G. Protein-energy wasting and mortality in chronic kidney disease. Int J Environ Res Public Health 2011;8(5):1631-54.