AUTHOR=Zemp Damiano D. , Giannini Olivier , Quadri Pierluigi , Tettamanti Mauro , Berwert Lorenzo , Lavorato Soraya , Pianca Silvio , Solcà Curzio , de Bruin Eling D. 

TITLE=A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.682198

DOI=10.3389/fmed.2022.682198

ISSN=2296-858X

ABSTRACT=Background
Patients with end stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in the renal replacement therapy. However, a closer examination of the transitional phase from pre-dialysis to long-term haemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of haemodialysis. We hypothesized that frailty is pre-existent in the pre-dialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a pre-dialysis program, with the expectation that replacement therapy would begin within the coming few months. 
Methods
The patients underwent a baseline visit before starting haemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, haematology parameters and adverse events were monitored during the study period. 
Results
At baseline our sample had a high variability, with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 no statistically significant decline in any clinical and functional measure a statistically significant worsening was only observed in SPPB score (p < 0.01, F = 8.50) and number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants – probably due to the pre-dialysis program – and a deterioration in the second year that in frail participants could lead to death. 
Conclusion
Our results should stimulate a reassessment about of the role importance, not only of a pre-dialysis program into reducinge complications during the transitional phase, but also aboutof frailty prevention programs once haemodialysis has begun, for both frail and fit patients, to maintain a satisfactory health status.