A Cohort Study to Investigate the Value of Exercise in ESRD/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD (ACTIVE/ADIPOSE)

General Description

Characteristics associated with the phenotype of frailty include fatigue and reduced physiologic capacity in neurologic control, mechanical performance, and energy metabolism. Studies have shown that there is an increased risk of frailty in chronic disease populations, including patients with chronic kidney disease undergoing hemodialysis. Currently, little is known about the prevalence or the contributing factors of frailty among patients with this condition. The ACTIVE/ADIPOSE (a Cohort Study to Investigate the Value of Exercise in ESRD/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD) study is a prospective, multicenter observational study designed to characterize the prevalence and progression of frailty among patients undergoing hemodialysis for end-stage renal disease (ESRD).

Patients at least 18 years of age who were on hemodialysis for at least three months were enrolled in the study. Participants were assessed using the validated Fried frailty index, which defines frailty as the presence of 3 or more criteria, including recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, and low physical activity. Information was collected on participants’ demographics, medical history, activity status, and mood, and physical performance was assessed via tests of grip strength, walk speed, and body composition. Additionally, blood draws were conducted semi-annually for evaluation of nutrition, inflammation, and cardiac markers. All participants were followed for two years. Logistic regression models were used to estimate the association of nutrition, cardiovascular, and rehabilitation parameters with patient frailty.

Analyses showed that peripheral vascular disease and cardiac diseases, such as dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest, were associated with higher odds for frailty. In contrast, black race and higher serum albumin concentration were associated with lower odds for frailty. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the two measures of physical performance. The association of these sociodemographic and clinical risk factors with wasting in this cohort provides evidence for the prevalence of frailty in hemodialysis patients.

Objectives

The primary aim of the ACTIVE/ADIPOSE study is to characterize the prevalence and progression of frailty among patients undergoing hemodialysis for end-stage renal disease.

Outcome Measure

Logistic regression models were used to determine the associations between nutrition, cardiovascular, and rehabilitation factors with the frailty phenotype.

Criteria

Patients of at least 18 years of age who spoke either English or Spanish, were on hemodialysis for at least three months, and gave informed consent were enrolled in the study.

Outcome

Analyses showed that peripheral vascular disease and cardiac diseases, such as dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest, were associated with higher odds for frailty. In contrast, black race and higher serum albumin concentration were associated with lower odds for frailty. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures. The association of these sociodemographic and clinical risk factors with wasting in this cohort provides evidence for the prevalence of frailty in hemodialysis patients. There is a need for prospective testing of interventions to address wasting or other components of the frailty syndrome to determine whether frailty can be reversed and whether improvements in frailty are associated with improved survival.