Study On The Frailty Status And Its Influential Factors Of Maintenance Hemodialysis Patients

Objectives1.To understand the status of frailty of maintenance hemodialysis patients.2.To explore the underlying factors of frailty based on the clinical knowledge of maintenance hemodialysis patients.3.To explain mechanisms on frailty by establishing a model on factors influencing frailty on patients with maintenance hemodialysis,so as to provide scientific references for taking the prevention and treatment on frailty in maintenance hemodialysis patients.MethodsDuring the period from March to October 2019,a convenience sample of 572 patients receiving the treatment of maintenance hemodialysis was recruited from the blood purification center of 5 tertiary general hospital in Tianjin.A series of scales,such as the self-made general demographic scale,FRAIL,International Physical Activity Questionnaire,Hospital Anxiety and Depression Scale,Self-management Scale of hemodialysis patients and Social Support Rating Scale were applied as the research tools,investigating all of the patients’frailty status and the key variables.The T-Test,Mann-Whitney U test、ANOVA、correlation analysis and the multiple linear step regression analysis in the software SPSS21.0 were used to compare the frailty levels of patients with different demographic characteristics.The Spearman correlation examined the association between theses variables,including physical activity,anxiety and depression,social support,self-management behaviors and frailty.A regression analysis was applied to verify the underlying aspects which would have influence on frailty levels in patients receiving maintenance hemodialysis.Based on the analysis of influential factors,we proposed a theoretical model of influential factors of frailty in maintenance hemodialysis patients,analyzing and validating this model by Amos21.0 software.Results1.The incidence of frailty in maintenance hemodialysis patients was 39.33%,pre-frailty41.25%,and non-frailty 19.4%.The proportion of fatigue was 73.4%,followed by 62.2%in five or more diseases,weight loss 35.7%,resistance 33.6%and walking ability 22.6%.2.The comparison of different scores of frailty based on demographic characteristics,showed that the gender,age,culture level,work status,dialysis age,complications,residual urine volume,calcium,hemoglobin,albumin,phosphorus,serum creatinine,C-reactive protein,urea nitrogen,parathormone and grip strength were statistically significant.However,there were not in the frailty levels of marital status,family monthly income,medical payment method,BMI,dialysis frequency,kidney transplantation,fall,vascular access or potassium.What’s more,the scores of anxiety,depression,physical activity,social support and self-management compared between groups were statistically significant.3.The results of Spearman correlation showed that frailty was negatively correlated with physical activity,self-management and social support(r=-0.493,-0.601,-0.478,p<0.01)and positively correlated with anxiety and depression(r=0.476,p<0.01).4.The regression analysis indicated that 11 variables including age,number of complications,hemoglobin,C-reactive protein,urea nitrogen,creatinine,grip strength,physical activity,anxiety and depression,self-management behavior and social support,explained 70.0%of the total frailty variation in maintenance hemodialysis patients.5.The results of structural equation model analysis revealed that 5 variables fit well with the theoretical model:(34)~2/df=2.844,GFI=0.951,AGFI=0.927,RMSEA=0.057.The self-management is the mediating variable of physical activity,anxiety,depression,and social support influencing frailty.ConclusionsThe prevalence of frailty in maintenance hemodialysis is at a high level,among which fatigue and number of complications account for the highest proportion.The major influential factors of frailty in patients with maintenance hemodialysis included the age,number of complications,hemoglobin,C-reactive protein,urea nitrogen,creatinine,grip strength,physical activity,anxiety and depression,social support,and self-management may have different effects on frailty.Self-management can affect frailty alone,and act as a bridge between other factors.Accordingly,the corresponding health care intervention measures can be formulated to guide patients to correctly understand,prevent and treat the frailty.