Objective This study aimed to investigate the current status of cognitive frailty (CF) in maintenance hemodialysis (MHD) patients and to analyze the influencing factors for CF. Methods A total of 258 MHD patients from July to October 2022 were recruited by a convenient sampling method. CF was assessed using the Montreal cognitive assessment (MoCA), frailty phenotype assessment, and clinical dementia rating (CDR) scale. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF. A CF risk prediction model was then developed, and a nomogram was constructed. The performance of the nomogram was assessed using area under the curve and calibration plots. Results The prevalence of CF in the surveyed MHD patients was 16.67%. Multivariate logistic regression revealed that the calf muscle circumference (OR=0.938, 95% CI:0.883～0.996,P=0.038), five-times-sit-to-stand test (OR=1.098,95% CI:1.023～1.178,P=0.009), the sarcopenia screening scale of SARC-F score (OR=0.938,95% CI:0.883～0.996,P=0.038), and the geriatric depression scale of GDS-15 score (OR=0.938,95% CI:0.883～0.996,P=0.038) were the independent factors influencing CF in MHD patients. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF, and a CF risk prediction model and a nomogram were then developed. The performance assessment of the nomogram showed that the area under the curve was 0.842 (95% CI:0.779～0.905) and the Hosmer and Lemeshow goodness of fit test was c2=5.163 and P=0.740. Conclusion The prevalence of CF is high in MHD patients. Healthcare professionals should prioritize the sarcopenia and depression screening and the related somatic measures to enable early identification and intervention of CF, thus delaying the onset and progression of CF in MHD patients.
YI Zi-Han
,
ZOU Zhao-Hua
,
CHENG Xin-Jie
,
XU Xing-Ying
,
ZHOU Na
,
LUO Huan
,
QING Wei
. Influencing factors and interventional measures for cognitive frailty in patients on maintenance hemodialysis[J]. Chinese Journal of Blood Purification, 2024
, 23(04)
: 272
-276
.
DOI: 10.3969/j.issn.1671-4091.2024.04.007
[1] Ji A，Pan C，Wang H，et al.Prevalence and Associated Risk Factors of Chronic Kidney Disease in an Elderly Population from Eastern China[J]. Int J Environ Res Public Health， 2019， 16(22).[J].Int J Environ Res Public Health, 2019, 16(22):-4383
[2]王善志，朱永俊，唐文庄，等.中国成人及老年人群慢性肾脏病患病率分析[J].中国老年学杂志, 2017, 37(21):5384-5388
[3]Andrassy K M.Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'[J].Kidney Int, 2013, 84(3):622-623
[4]吴静，邓志宽，赵景宏，等.慢性肾病对患者认知功能的影响及其相关因素的初步研究[J].第三军医大学学报, 2016, 38(15):1773-1776
[5] Chowdhury R，Peel N M，Krosch M，et al.Frailty and chronic kidney disease: A systematic review[J]. Arch Gerontol Geriatr， 2017， 68: 135-142.[J].Arch Gerontol Geriatr, 2017, 68:135-142
[6]韩飒飒，王艳梅.老年人认知衰弱评估及危险因素研究进展[J].护理研究, 2021, 35(07):1199-1202
[7]Robertson D A，Savva G M，Kenny R A.Frailty and cognitive impairment--a review of the evidence and causal mechanisms[J].Ageing Res Rev, 2013, 12(4):840-851
[8]Kelaiditi E，Cesari M，Canevelli M，et al.Cognitive frailty: rational and definition from an (IA.N.A.I.A.G.G.) international consensus group[J].J Nutr Health Aging, 2013, 17(9):726-734
[9]Zhang X M，Wu X J，Cao J，et al.Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis[J].J Nutr Health Aging, 2022, 26(9):817-825
[10]Feng L，Zin N M，Gao Q，et al.Cognitive Frailty and Adverse Health Outcomes: Findings From the Singapore Longitudinal Ageing Studies (SLAS)[J].J Am Med Dir Assoc, 2017, 18(3):252-258
[11]Solfrizzi V，Scafato E，Seripa D，et al.Reversible Cognitive Frailty,Dementia,and All-Cause MortalityThe Italian Longitudinal Study on Aging[J].J Am Med Dir Assoc, 2017, 18(1):81-89
[12] Ruan Q, D' Onofrio G, Sancarlo D, et al.Emerging biomarkers and screening for cognitive frailty. Aging Clin Exp Res. 2017, 29(6):1075-1086.?[J].Aging Clin Exp Res, 2017, 29(6):1075-1086
[13]王利芳, 尹彬洁, 郭佳玉等.老年血液透析患者认知衰弱现状及其影响因素分析[J].医学信息, 2021, 34(03):142-145
[14]李梅.老年维持性血液透析病人认知衰弱风险预测模型的建立[J].全科护理, 2023, 21(10):1392-1396
[15]高翔，梅长林.慢性肾脏病早期筛查、诊断及防治指南年版》解读[J].中国实用内科杂志, 2022, 42(09):735-739
[16] 江山秀.维持性血液透析患者衰弱风险预测模型的构建[D]. 湖州师范学院，2022.
[17]崔光辉，李少杰，尹永田，等.老年人偏颇体质在久坐行为与认知衰弱间的中介效应研究[J].中国全科医学, 2021, 24(18):2297-2302
[18]郁阿翠，陈喜，杨萌娜，等.老年人营养不良状况及影响因素分析[J].实用老年医学, 2022, 36(08):822-826
[19]Nasreddine Z S，Phillips N A，Bédirian V，et al.The Montreal Cognitive Assessment,MoCA: a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc, 2005, 53(4):695-699
[20]Fried L P，Tangen C M，Walston J，et al.Frailty in older adults: evidence for a phenotype[J].J Gerontol A Biol Sci Med Sci, 2001, 56(3):M146-M156
[21] Bouillon K，Kivimaki M，Hamer M，et al.Measures of frailty in population-based studies: an overview[J]. BMC Geriatr， 2013， 13: 64.
[22] Hughes C P，Berg L，Danziger W L，et al.A new clinical scale for the staging of dementia[J]. Br J Psychiatry， 1982， 140: 566-572.[J].Br J Psychiatry, 1982, 140:566-572
[23]Malmstrom T K，Miller D K，Simonsick E M，et al.SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes[J].J Cachexia Sarcopenia Muscle, 2016, 7(1):28-36
[24] 孟涵.渐进性抗阻训练对高龄肌少症住院患者日常生活能力及营养状况影响的研究[D]. 南昌大学，2021.
[25]Yesavage J A，Brink T L，Rose T L，et al.Development and validation of a geriatric depression screening scale: a preliminary report[J].J Psychiatr Res, 1982, 17(1):37-49
[26]中国痴呆与认知障碍诊治指南写作组，中国医师协会神经内科医师分会认知障碍疾病专业委员会.中国痴呆与认知障碍诊治指南五：轻度认知障碍的诊断与治疗[J].中华医学杂志, 2018, 98(17):1294-1301
[27]林玉珠，蒋运兰，刘跃，等.我国老年人认知衰弱发生率的分析[J].职业与健康, 2022, 38(01):121-124
[28]Chang J，Hou W，Li Y，et al.Prevalence and associated factors of cognitive frailty in older patients with chronic kidney disease: a cross-sectional study[J].BMC Geriatr, 2022, 22(1):681-
[29]Drew D A，Weiner D E，Sarnak M J.Cognitive Impairment in CKD: Pathophysiology,Management,and Prevention[J].Am J Kidney Dis, 2019, 74(6):782-790
[30]Sacre J W，Magliano D J，Zimmet P Z，et al.Associations of Chronic Kidney Disease Markers with Cognitive Function: A 12-Year Follow-Up Study[J].J Alzheimers Dis, 2019, 70(s1):S19-S30
[31] Nitta K，Hanafusa N，Tsuchiya K.Role of Frailty on Outcomes of Dialysis Patients[J]. Contrib Nephrol， 2018， 195: 102-109.
[32] Kim M，Jeong M J，Yoo J，et al.Calf Circumference as a Screening Tool for Cognitive Frailty in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)[J]. J Clin Med， 2018， 7(10).
[33]Landi F，Onder G，Russo A，et al.Calf circumference,frailty and physical performance among older adults living in the community[J].Clin Nutr, 2014, 33(3):539-544
[34]Zhu Y X，Zhang Y，Wang Y Y，et al.Low calf circumference is associated with frailty in diabetic adults aged over 80 years[J].BMC Geriatr, 2020, 20(1):414-
[35] Easton J F，Stephens C R，Román-Sicilia H，et al.Anthropometric measurements and mortality in frail older adults[J]. Exp Gerontol， 2018， 110: 61-66.
[36]Won H，Abdul M Z，Mat L A，et al.Wide range of body composition measures are associated with cognitive function in community-dwelling older adults[J].Geriatr Gerontol Int, 2017, 17(4):554-560
[37]Cruz-Jentoft A J，Bahat G，Bauer J，et al.Sarcopenia: revised European consensus on definition and diagnosis[J].Age Ageing, 2019, 48(4):601-
[38]Batista F S，Gomes G A，D' Elboux M J，et al.Relationship between lower-limb muscle strength and functional independence among elderly people according to frailty criteria: a cross-sectional study[J].Sao Paulo Med J, 2014, 132(5):282-289
[39]Dodds R M，Murray J C，Granic A，et al.Prevalence and factors associated with poor performance in the 5-chair stand test: findings from the Cognitive Function and Ageing Study II and proposed Newcastle protocol for use in the assessment of sarcopenia[J].J Cachexia Sarcopenia Muscle, 2021, 12(2):308-318
[40]陈静，刘一秀，罗细菊，等.运动干预对维持性血液透析患者躯体功能影响的分析[J].中国血液净化, 2022, 21(11):850-857
[41]王姣锋，纪雪莹，崔月，等.老年住院患者躯体衰弱和认知衰弱状况及其影响因素研究[J].老年医学与保健, 2019, 25(04):451-455
[42] Inoue T，Shimizu A，Satake S，et al.Association between osteosarcopenia and cognitive frailty in older outpatients visiting a frailty clinic[J]. Arch Gerontol Geriatr， 2022， 98: 104530.
[43]Peng T C，Chen W L，Wu L W，et al.Sarcopenia and cognitive impairment: A systematic review and meta-analysis[J].Clin Nutr, 2020, 39(9):2695-2701
[44]廖诗沁，蒋运兰，李洁，等.中国维持性血液透析患者肌少症检出率的分析[J].牡丹江医学院学报, 2022, 43(05):99-102
[45]何茂芯，袁怀红，杨玉洁，等.维持性血液透析患者肌少症与衰弱的临床研究进展[J].华西医学, 2022, 37(11):1720-1725
[46]王利芳，尹彬洁，郭佳玉，等.老年血液透析患者认知衰弱现状及其影响因素分析[J].医学信息, 2021, 34(03):142-145
[47]孔令磷，赵慧敏，刘玥婷，等.社区老年型糖尿病患者认知衰弱现状及影响因素[J].护理学杂志, 2020, 35(07):89-92
[48]Kwan R，Leung A，Yee A，et al.Cognitive Frailty and Its Association with Nutrition and Depression in Community-Dwelling Older People[J].J Nutr Health Aging, 2019, 23(10):943-948
[49]林丽玉，许丽春，张鑫，等.老年认知衰弱的危险因素分析[J].现代预防医学, 2022, 49(09):1653-1658
[50] Collister D，Rodrigues J C，Mazzetti A，et al.Single Questions for the Screening of Anxiety and Depression in Hemodialysis[J]. Can J Kidney Health Dis， 2019， 6: 2048262687.
[51] Zheng L, Wang C, Qiu Y, et al.Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials[J]. Age Ageing. 2022, 51(12):afac286.
[52]李晓华, 张艳, 高月等.老年人认知衰弱健康管理的研究进展[J].中国慢性病预防与控制, 2022, 30(09):707-711
