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Abstract
Purpose
This study was to examine the relationships among frailty, physical performance, exercise self-efficacy, decisional balance, and health-related quality of life (HRQoL) and to identify the impact factors on frailty in adults undergoing hemodialysis.
Methods
In this cross-sectional study, 96 adults (41 women, 55 men, age 57.10±13.56 years) were enrolled an university hospital-affiliated outpatient hemodialysis clinic. Participants were asked to ad-minister questionnaires including exercise change stages, exercise self-efficacy, decisional balance, and HRQoL. Participants also completed measures of the short battery physical performance test (SPPB), usual gait speed, grip strength (JAMAR Hand Dynamometer, Paterson medical Ltd. Warrenville, USA), and body composition (Inbody S10, Biospace company, Seoul, Korea). Frailty status was classified according to the frailty phenotype developed by Fried using gait speed, grip strength, vitality from mental HRQoL, physical activity from exercise change stages, and body mass index.
Results
According to frailty scores, 56.3% (n=54) were frail (frailty scores 3-5) and 43.7% were non-frail (frailty scores 0-2). Exercise self-efficacy, pros decisional balance, and HRQoL were lower in the frail patients (all p<.05). Frailty correlated with worse scores of SPPB(r=-.56), exercise self-efficacy (r=-.40), pros decisional balance (r=-.24), and physical and mental HRQoL (r=-.32; r=-.26) by Spearman correlation analysis. Factors associated with non-frailty includes higher SPPB (odds ratio: 1.67, 95% confidence interval: 1.15~2.44) and exercise self-efficacy(odds ratio 1.17, 95% confidence interval: 1.03~1.33).
REFERENCES
1. Jin DC, Yun SR, Lee SW, Han SW, Kim W, Park J, et al. Lessons from 30 years' data of Korean end-stage renal disease registry, 1985-2015. Kidney Research and Clinical Practice. 2015; 34(3):132–9. https://doi.org/10.1016/j.krcp.2015.08.004.
2. Aucella F, Battaglia Y, Bellizzi V, Bolignano D, Capitanini A, Cupisti A. Physical exercise programs in CKD: lights, shades and perspectives: a position paper of the "Physical Exercise in CKD Study Group" of the Italian society of nephrology. Journal of Nephrology. 2015; 28(2):143–50. https://doi.org/10.1007/s40620-014-0169-6.
3. Kang SH, Do JY, Lee SY, Kim JC. Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients. PLoS One. 2017; 12(5):e0176814. https://doi.org/10.1371/journal.pone.0176814.
4. Makizako H, Shimada H, Doi T, Tsutsumimoto K, Suzuki T. Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study. British Medical Journal Open. 2015; 5(9):e008462. https://doi.org/10.1136/bmjopen-2015-008462.
5. Kutner NG, Zhang R, Allman RM, Bowling CB. Correlates of ADL difficulty in a large hemodialysis cohort. Hemodialysis International. 2014; 18(1):70–7. https://doi.org/10.1111/hdi.12098.
6. Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of frailty among dialysis patients. Journal of American Society of Nephrology. 2007; 18(11):2960–7. https://doi.org/10.1681/ASN.2007020221.
7. Delgado C, Doyle JW, Johansen KL. Association of frailty with body composition among patients on hemodialysis. Journal of Renal Nutrition. 2013; 23(5):356–62. https://doi.org/10.1053/j.jrn.2013.02.010.
8. Reese PP, Cappola AR, Shults J, Townsend RR, Gadegbeku CA, Anderson C, et al. Physical performance and frailty in chronic kidney disease. American Journal of Nephrology. 2013; 38(4):307–15. https://doi.org/10.1159/000355568.
9. Walker SR, Brar R, Eng F, Komenda P, Rigatto C, Prasad B, et al. Frailty and physical function in chronic kidney disease: the CanFIT study. Canadian Journal of Kidney Health and Disease. 2015; 2:32. https://doi.org/10.1186/s40697-015-0067-4.
10. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2001; 56(3):M146–57. https://doi.org/10.1093/gerona/56.3.M146.
11. Freedman VA. Adopting the ICF language for studying late-life disability: a field of dreams? The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2009; 64A(11):1172–4. https://doi.org/10.1093/gerona/glp095.
12. Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clinical Journal of American Society of Nephrology. 2013; 8(5):861–72. https://doi.org/10.2215/cjn.06590712.
13. National Kidney Foundation: K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American Journal of Kidney Disease. 2005; 45(Suppl 3):16–153. https://doi.org/10.1053/j.ajkd.2005.01.019.
14. Delgado C, Johansen KL. Barriers to exercise participation among dialysis patients. Nephrology, Dialysis, Transplantation. 2012; 27(3):1152–7. https://doi.org/10.1093/ndt/gfr404.
15. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport. 1992; 63(1):60–6. https://doi.org/10.1080/02701367.1992.10607557.
16. Guo YJ, Tang Q, Gu Y. Measurements of self-efficacy in patients with chronic kidney disease: a literature review. Nephrology Nursing Journal. 2017; 44(2):159–76.
17. Wu SF, Hsieh NC, Lin LJ, Tsai JM. Prediction of self-care be-haviour on the basis of knowledge about chronic kidney disease using self-efficacy as a mediator. Journal of Clinical Nursing. 2016; 25(17-18):2609–18. https://doi.org/10.1111/jocn.13305.
18. Abbaspour S, Farmanbar R, Najafi F, Ghiasvand AM, Dehghan-kar L. Decisional balance and self-efficacy of physical activity among the elderly in Rasht in 2013 based on the transtheoreti-cal model. Electronic Physician. 2017; 9(5):4447–53. https://doi.org/10.19082/4447.
19. Chang HK. Influence of frailty, nutritional status, positive thinking, and family function on health conservation of the elderly at home. Korean Journal of Adult Nursing. 2015; 27(1):52–62. https://doi.org/10.7475/kjan.2015.27.1.52.
20. Nigg CR, Rossi JS, Norman GJ, Benisovich SV. Structure of decisional balance for exercise adoption. Annals of Behavioral Medicine. 1998; 20:S211.
21. Lee SJ, Son H, Shin SK. Influence of frailty on health-related quality of life in pre-dialysis patients with chronic kidney disease in Korea: a cross-sectional study. Health and Quality of Life Outcomes. 2015; 13(70):https://doi.org/10.1186/s12955-015-0270-0.
22. Jang EJ, Kim HS. Effects of exercise intervention on physical fitness and health-relalted quality of life in hemodialysis patients. Journal of Korean Academy of Nursing. 2009; 39(4):584–93. https://doi.org/10.4040/jkan.2009.39.4.584.
23. Tao X, Chow SK, Wong FK. A nurse-led case management program on home exercise training for hemodialysis patients: a randomized controlled trial. International Journal of Nursing Studies. 2015; 52(6):1029–41. https://doi.org/10.1016/j.ijnurstu.2015.03.013.
24. National Kidney Foundation. Kidney Dialysis Outcome Quality Initiative (K/DOQI) [Internet]. Clinical practice guidelines for hemodialysis adequacy: updates. 2006. [cited 2017 April 19]. Available from:. http://www2.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide2.htm. http://www2.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/hd_guide2.htm.
25. Molsted S, Eidemak I, Sorensen HT, Kristensen JH. Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health. Nephron Clinical Practice. 2004; 96(3):c76–81. https://doi.org/10.1159/000076744.
26. Kim JK, Choi SR, Choi MJ, Kim SG, Lee YK, Noh JW, et al. Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease. Clinical Nutrition. 2014; 33(1):64–8. https://doi.org/10.1016/j.clnu.2013.04.002.
27. Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, et al. Association between body composition and frailty among prevalent hemodialysis patients: a US renal data system special study. Journal of the American Society of Nephrology. 2014; 25(2):381–9. https://doi.org/10.1681/ASN.2013040431.
28. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-report-ed disability and prediction of mortality and nursing home admission. Journal of Gerontology. 1994; 49(2):M85–94. https://doi.org/10.1093/geronj/49.2.M85.
29. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item se-lection. Medical Care. 1992; 30(6):473–83.
30. Lopes AA, Lantz B, Morgenstern H, Wang M, Bieber BA, Gillespie BW, et al. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clinical Journal of the American Society of Nephrology. 2014; 9(10):1702–12. https://doi.org/10.2215/CJN.12371213.
Table 1.
Characteristics and Frailty Phenotype among Hemodialysis Patients (N=96)
| Variables | Characteristics | Categories | s | Total (N=96) | Not frail (n=42) | Frail (n=54) | χ² or t or F | p |
|---|---|---|---|---|---|---|---|---|
| s | n (%) or M± SD | n (%) or M± SD | n (%) or M± SD | |||||
| Characteristics | Gender | Male | 55 (57.3) | 29 (69.0) | 26 (48.1) | 4.22 | .040 | |
| Female | 41 (42.7) | 13 (31.0) | 28 (51.9) | |||||
| Age (year) | 57.10±13.56 | 54.41±12.87 | 59.20±13.83 | -1.74 | .085 | |||
| 50 | 28 (29.2) | 13 (31.0) | 15 (27.8) | 5.20 | .074 | |||
| 50~64 | 41 (42.7) | 22 (52.4) | 19 (35.2) | |||||
| ≥65 | 27 (28.1) | 7 (16.6) | 20 (37.0) | |||||
| Spouse | Yes | 71 (74.0) | 33 (78.6) | 38 (70.4) | 0.83 | .364 | ||
| No | 25 (26.0) | 9 (21.4) | 16 (29.6) | |||||
| Religion | Yes | 58 (60.4) | 22 (52.4) | 36 (66.7) | 2.02 | .156 | ||
| No | 38 (39.6) | 20 (47.6) | 18 (33.3) | |||||
| Education | ≤ High sch | hool | 64 (66.7) | 24 (57.1) | 40 (74.1) | 3.05 | .081 | |
| ≥ College | 32 (33.3) | 18 (42.9) | 14 (25.9) | |||||
| Job | Yes | 34 (35.4) | 20 (47.6) | 14 (25.9) | 4.86 | .027 | ||
| No | 62 (64.6) | 22 (52.4) | 40 (74.1) | |||||
| ESRD cause | DM | 46 (47.9) | 17 (40.5) | 29 (53.7) | 7.41 | .060 | ||
| HTN | 24 (25.0) | 16 (38.1) | 8 (14.8) | |||||
| CGN | 9 (9.4) | 4 (9.5) | 5 (9.3) | |||||
| Others | 17 (17.7) | 5 (11.9) | 12 (22.2) | |||||
| Comorbidity | CCI | 5.67±2.25 | 4.91±1.95 | 6.26±2.30 | -3.06 | .003 | ||
| HD duration (month) | 55.81±60.38 | 38.86±40.94 | 69.00±69.52 | -2.65 | .010 | |||
| Kt/V | 1.64±0.30 | 1.57±0.30 | 1.70±0.28 | -2.13 | .036 | |||
| Albumin (g/dL) | 3.89±0.49 | 4.02±0.27 | 3.79±0.59 | 2.57 | .012 | |||
| Hemoglobin (g/dL) | 10.35±1.13 | 10.21±1.32 | 10.45±0.96 | -1.05 | .297 | |||
| Frailty phenotype | Slowness | 0.86±0.35 | 1.00±0.24 | 0.74±0.39 | 5.02 | .028‡ | ||
| Gait speed (m/s) | ≥0.8 | (0) | 59 (61.5) | 34 (81.0) | 25 (46.3) | 11.98 | .001 | |
| 0.8 | (1) | 37 (38.5) | 8 (19.0) | 29 (53.7) | ||||
| Weakness | 24.92±9.50 | 30.26±9.59 | 20.76±7.09 | 11.50 | .001‡ | |||
| Grip strength (kg) | Normal | (0) | 49 (51.0) | 34 (81.0) | 15 (27.8) | 26.73 | .001 | |
| Weak | (1) | 47 (49.0) | 8 (19.0) | 39 (72.2) | ||||
| Physical activity | Yes | (0) | 30 (31.3) | 26 (61.9) | 4 (7.4) | - | .001† | |
| No | (1) | 66 (68.6) | 16 (38.1) | 50 (92.6) | ||||
| Exercise change stages | Maintenance | 30 (31.3) | 26 (61.9) | 4 (7.4) | 26.50 | .001† | ||
| Action | 16 (16.7) | 5 (11.9) | 11 (20.4) | |||||
| Preparation | 13 (13.5) | 2 (4.8) | 11 (20.4) | |||||
| Contemplation | 11 (11.4) | 7 (16.6) | 4 (7.4) | |||||
| Precontemplation | 26 (27.1) | 2 (4.8) | 24 (44.4) | |||||
| Exhaustion | 43.53±11.14 | 49.53±10.83 | 38.86±9.00 | 23.56 | .001‡ | |||
| Vitality in SF-36 | ≥55 | (0) | 17 (17.7) | 15 (35.7) | 2 (3.7) | - | .001† | |
| 55 | (1) | 79 (82.3) | 27 (64.3) | 52 (96.3) | ||||
| Weight loss | 22.01±3.40 | 23.18±3.40 | 21.11±3.15 | 9.86 | .002‡ | |||
| BMI (kg/m²) | ＞18.5 | (0) | 82 (85.4) | 40 (95.2) | 42 (77.8) | - | .020† | |
| ≤18.5 | (1) | 14 (14.6) | 2 (4.8) | 12 (22.2) | ||||
| Body composition | Muscle (kg) | 24.47±5.30 | 26.72±6.10 | 22.71±3.79 | 3.24 | .075‡ | ||
| Fat (%) | 20.18±10.11 | 18.86±10.67 | 21.21±9.62 | 0.45 | .505‡ | |||
| Frailty score | (0~5) | 2.53±1.11 | 1.45±0.59 | 3.37±0.56 | -16.23 | .001‡ | ||
Table 2.
Short Physical Performance Battery, Exercise Self-efficacy, Decisional Balance, and Health-related Quality of Life according to Performance based Frailty (N=96)
| Variables | Categories | Total (N=96) | Not frail (n=42) | Frail (n=54) | x2 or F | p |
|---|---|---|---|---|---|---|
| n (%) or M± SD | n (%) or M± SD | n (%) or M± SD | ||||
| SPPB (0~12) | 9.39±3.10 | 11.12±1.43 | 8.04±3.38 | 13.07 | .001 | |
| ≥10 | 58 (60.4) | 36 (85.7) | 22 (40.7) | .001† | ||
| 10 | 38 (39.6) | 6 (14.3) | 32 (59.3) | |||
| Balance (0~4) | 3.29±1.10 | 3.74±0.66 | 2.94±1.25 | 5.83 | .018 | |
| 4m Gait speed (0~4) | 3.21±1.15 | 3.83±0.44 | 2.72±1.29 | 13.27 | .001 | |
| 5 Chair stand (0~4) | 2.98±1.30 | 3.52±0.89 | 2.56±1.41 | 4.61 | .034 | |
| Exercise self-efficacy | 16.14±6.39 | 18.93±5.39 | 13.96±6.30 | 12.28 | .001 | |
| Decisional balance | Pros | 17.34±5.34 | 19.17±4.14 | 15.93±5.76 | 3.21 | .002 |
| Cons | 21.85±3.11 | 22.21±2.76 | 21.57±3.35 | 1.00 | .319 | |
| Health-related quality of life | Physical functioning | 44.53±10.38 | 49.17±7.19 | 40.92±11.09 | 6.60 | .012 |
| Role limitation-physical | 43.73±11.05 | 45.62±9.59 | 42.26±11.95 | 1.78 | .186 | |
| Bodily pain | 49.56±11.45 | 52.75±9.22 | 47.07±12.45 | 3.74 | .056 | |
| General health | 37.39±10.00 | 37.85±9.88 | 37.03±10.16 | 1.00 | .320 | |
| Vitality | 43.53±11.14 | 49.53±10.83 | 38.86±9.00 | 23.56 | .001 | |
| Social functioning | 47.39±9.67 | 49.73±8.78 | 45.58±10.01 | 3.76 | .056 | |
| Role limitation-emotional | 45.95±11.90 | 49.16±8.40 | 43.46±13.59 | 4.62 | .034 | |
| Mental health | 48.44±9.58 | 46.65±10.17 | 47.49±9.07 | 0.48 | .481 | |
| PCS | 43.25±8.05 | 46.19±7.52 | 40.96±7.76 | 5.54 | .021 | |
| MCS | 47.44±10.19 | 49.91±9.37 | 45.52±10.46 | 4.62 | .034 |
Table 3.
Relationships of Frailty Phenotype with Short Physical Performance Battery, Exercise Self-efficacy, Decisional Balance, and Health-related Quality of Life (N=96)
Table 4.
Influences on the Performance based Frailty (N=96)
Logistic regression adjusted by covariates (gender, age, job, albumin, CCI=Charlson comorbidity index, dialysis duration, Kt/V: K=dialyser's capacity to clear urea at the blood flow rate, t=treatment time, V=distribution volume of urea); SE=standard errors; df=degree of freedom; Exp.=exponentiated coefficients; CI=confidence interval; SPPB=short physical performance battery; Performance based frailty: Normal=1, Frail=0; Dummy variables: gender (Male=0, Female=1), Job (Yes=1, No=0); PCS=physical component summary.
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