Frailty in advanced diabetic nephropathy: associated factors in patients on hemodialysis and peritoneal dialysis.

Abstract

Introduction: Diabetic nephropathy is the leading cause of end-stage renal disease. Treatments such as hemodialysis and peritoneal dialysis give rise to complications that promote the development of frailty syndrome, thereby significantly increasing the risk of disability and mortality. However, there is limited local evidence directly comparing this functional decline between the two dialysis modalities.

Materials and Methods: An observational, analytical, cross-sectional study was conducted at the UNIREAS dialysis center in Cuenca, evaluating a sample of 58 adult patients with diabetic nephropathy undergoing dialysis therapy. Each participant's frailty level was determined using the Fried phenotype criteria, while the clinical burden of comorbidities was quantified using the Charlson Comorbidity Index. Subsequently, the data underwent bivariate statistical analysis using parametric and non-parametric tests.

Results: The prevalence of frailty reached 56.9% among patients, while an additional 37.9% exhibited pre-frailty. No statistically significant differences in frailty were found between the groups undergoing hemodialysis (56.9%) and peritoneal dialysis (57.1%). Among the components of the Fried phenotype, muscle weakness was the most frequent, identified in 81.0% of subjects. Additionally, 82.8% presented a high comorbidity burden; bivariate analysis showed no statistical association between frailty and comorbidities, sociodemographic variables, duration of dialysis, or years since clinical onset.

Conclusions: There is a high prevalence of physical frailty in patients with diabetic nephropathy undergoing renal replacement therapies, regardless of the dialysis modality employed. Given the marked prevalence of muscle weakness, it is a priority to incorporate routine functional screening and promote early physical rehabilitation programs aimed at mitigating this physiological decline.