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existen condiciones y enfermedades que provocan cambios semejantes al envejecimiento y pueden derivar en un estado de fragilidad en edades m&#225;s j&#243;venes&#59; una de estas situaciones es la enfermedad renal cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; As&#237;&#44; algunos estudios han estimado la prevalencia de fragilidad en pacientes en hemodi&#225;lisis en un 26 a un 73&#37;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Esta gran variabilidad se puede explicar por las diferencias en las poblaciones estudiadas y las distintas herramientas empleadas en la valoraci&#243;n de la fragilidad<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; En nuestro pa&#237;s&#44; hasta el momento actual no se han publicado estudios sobre prevalencia de fragilidad en pacientes en hemodi&#225;lisis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nuestro objetivo fue estimar la prevalencia de fragilidad en los pacientes en hemodi&#225;lisis en el &#225;rea sanitaria sur de Gran Canaria y estudiar algunos factores demogr&#225;ficos&#44; cl&#237;nicos y anal&#237;ticos asociados a la misma&#46; Para ello se dise&#241;&#243; un estudio transversal de 277 pacientes en hemodi&#225;lisis estimando la fragilidad mediante el Fried Phenotype Frail Index &#40;FPFI&#41; y la Edmonton Frail Scale &#40;EFS&#41;&#46; El FPFI eval&#250;a de forma estandarizada 5 &#237;tems que miden debilidad&#44; lentitud&#44; agotamiento&#44; baja actividad f&#237;sica y p&#233;rdida de peso&#46; La EFS eval&#250;a 11 &#237;tems que miden adem&#225;s otras esferas de la fragilidad&#44; como la cognitiva&#44; la psicol&#243;gica o la social&#46; Se recogieron datos demogr&#225;ficos y cl&#237;nicos&#44; el &#237;ndice de comorbilidad de Charlson y par&#225;metros anal&#237;ticos&#46; Posteriormente se realiz&#243; un seguimiento a un a&#241;o para valorar la mortalidad seg&#250;n la fragilidad&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La prevalencia de pacientes fr&#225;giles con el FPFI fue del 41&#44;2&#37; y con la EFS&#44; del 29&#44;6&#37;&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra en gr&#225;ficos las prevalencias encontradas con ambos test&#46; Hallamos una falta de concordancia entre los resultados&#59; de los pacientes fr&#225;giles con EFS un 83&#37; eran fr&#225;giles con FPFI y un 17&#37; prefr&#225;giles&#44; y de los pacientes fr&#225;giles con FPFI un 60&#37; eran fr&#225;giles con EFS y un 40&#37; vulnerables o no fr&#225;giles&#46; El EFS clasificaba un mayor n&#250;mero de pacientes como no fr&#225;giles&#44; mientras que el FPFI clasificaba un mayor n&#250;mero como prefr&#225;giles&#46; Es dif&#237;cil valorar en un estudio transversal la raz&#243;n y las implicaciones pron&#243;sticas de esta discordancia en los resultados&#44; pero podr&#237;a deberse a las diferentes esferas de la fragilidad que se miden con cada uno de los test&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las principales caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas y anal&#237;ticas seg&#250;n los resultados de ambos test&#46; En dicha tabla puede observarse que existe una asociaci&#243;n entre fragilidad y otros datos cl&#237;nicos de mal pron&#243;stico&#44; como son la edad avanzada&#44; la presencia de diabetes mellitus&#44; un mayor &#237;ndice de comorbilidad de Charlson y el sexo femenino&#46; Entre los par&#225;metros anal&#237;ticos se observ&#243; una discreta disminuci&#243;n de hemoglobina&#44; alb&#250;mina y &#225;cido &#250;rico estad&#237;sticamente significativa en los grupos prefr&#225;giles y fr&#225;giles con respecto al de no fr&#225;giles&#46; No observamos diferencias en los par&#225;metros del metabolismo &#243;seo-mineral ni en el perfil lip&#237;dico entre los grupos&#46; Se observa un descenso significativo de la CPK con la fragilidad&#44; que podr&#237;a reflejar una disminuci&#243;n de la masa muscular por la sarcopenia asociada a la fragilidad&#46; Tambi&#233;n observamos un aumento de algunos par&#225;metros anal&#237;ticos que han sido descritos como marcadores de mal pron&#243;stico por su relaci&#243;n con la inflamaci&#243;n o con la sobrehidrataci&#243;n&#44; como la prote&#237;na C reactiva&#44; el NT-proBNP y la amplitud de distribuci&#243;n eritrocitaria&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">En el seguimiento a un a&#241;o se observ&#243; una mortalidad del 21&#44;1&#37; en los pacientes fr&#225;giles frente a un 11&#37; en los pacientes prefr&#225;giles y no fr&#225;giles con el FPFI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Se observ&#243; una mortalidad del 26&#44;8&#37; en los pacientes fr&#225;giles frente a un 10&#44;3&#37; en los pacientes vulnerables y no fr&#225;giles con el EFS &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; observamos una alta prevalencia de fragilidad en los pacientes en hemodi&#225;lisis&#46; La presencia de fragilidad se asocia a una mala evoluci&#243;n a corto plazo&#46; Sin embargo&#44; encontramos una falta de concordancia entre los test utilizados para mediar la fragilidad&#44; por lo que se hace necesario realizar m&#225;s estudios para validar los test de fragilidad en pacientes en hemodi&#225;lisis&#44; determinar su valor pron&#243;stico y establecer el impacto de las posibles medidas terap&#233;uticas para revertir la fragilidad en este grupo de pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">Este trabajo ha sido financiado en parte con una beca de la XXI convocatoria I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>E del Colegio Oficial de M&#233;dicos de Las Palmas&#46;</p></span></span>"
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                  """
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          "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas y anal&#237;ticas</p>"
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                    0 => array:1 [
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                        "tituloSerie" => "Aging Clin Exp Res"
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                        "numero" => "3 Suppl"
                        "paginaInicial" => "1"
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Carta al Director
Prevalencia de fragilidad y factores asociados en pacientes en programa de hemodiálisis
Frailty prevalence and associated factors in hemodialysis patients
César García-Cantóna,b,
Autor para correspondencia
cgarcan@gmail.com

Autor para correspondencia.
, Ana Ródenas Gálveza, Celia Lopez Aperadorb, Yaiza Riveroa, Noa Diaza, Gloria Antónc, Noemi Esparzaa
a Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
b Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
c Centro de Hemodiálisis Avericum, Las Palmas de Gran Canaria, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La fragilidad ha sido definida como un s&#237;ndrome o estado de deterioro y aumento de la vulnerabilidad a situaciones de estr&#233;s que se produce con el envejecimiento&#46; Se caracteriza por debilidad y descenso de las reservas funcionales biol&#243;gicas&#44; lo que lleva a un riesgo aumentado de evoluci&#243;n desfavorable hacia la discapacidad&#44; la hospitalizaci&#243;n y el fallecimiento<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; La fragilidad es un concepto diferente a la discapacidad y a la comorbilidad&#59; aunque los 3 conceptos est&#225;n muy relacionados y se influyen unos a otros&#44; no siempre coexisten<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A pesar de que la fragilidad se ha definido generalmente asociada a la edad avanzada y al envejecimiento&#44; existen condiciones y enfermedades que provocan cambios semejantes al envejecimiento y pueden derivar en un estado de fragilidad en edades m&#225;s j&#243;venes&#59; una de estas situaciones es la enfermedad renal cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; As&#237;&#44; algunos estudios han estimado la prevalencia de fragilidad en pacientes en hemodi&#225;lisis en un 26 a un 73&#37;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Esta gran variabilidad se puede explicar por las diferencias en las poblaciones estudiadas y las distintas herramientas empleadas en la valoraci&#243;n de la fragilidad<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; En nuestro pa&#237;s&#44; hasta el momento actual no se han publicado estudios sobre prevalencia de fragilidad en pacientes en hemodi&#225;lisis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nuestro objetivo fue estimar la prevalencia de fragilidad en los pacientes en hemodi&#225;lisis en el &#225;rea sanitaria sur de Gran Canaria y estudiar algunos factores demogr&#225;ficos&#44; cl&#237;nicos y anal&#237;ticos asociados a la misma&#46; Para ello se dise&#241;&#243; un estudio transversal de 277 pacientes en hemodi&#225;lisis estimando la fragilidad mediante el Fried Phenotype Frail Index &#40;FPFI&#41; y la Edmonton Frail Scale &#40;EFS&#41;&#46; El FPFI eval&#250;a de forma estandarizada 5 &#237;tems que miden debilidad&#44; lentitud&#44; agotamiento&#44; baja actividad f&#237;sica y p&#233;rdida de peso&#46; La EFS eval&#250;a 11 &#237;tems que miden adem&#225;s otras esferas de la fragilidad&#44; como la cognitiva&#44; la psicol&#243;gica o la social&#46; Se recogieron datos demogr&#225;ficos y cl&#237;nicos&#44; el &#237;ndice de comorbilidad de Charlson y par&#225;metros anal&#237;ticos&#46; Posteriormente se realiz&#243; un seguimiento a un a&#241;o para valorar la mortalidad seg&#250;n la fragilidad&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La prevalencia de pacientes fr&#225;giles con el FPFI fue del 41&#44;2&#37; y con la EFS&#44; del 29&#44;6&#37;&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra en gr&#225;ficos las prevalencias encontradas con ambos test&#46; Hallamos una falta de concordancia entre los resultados&#59; de los pacientes fr&#225;giles con EFS un 83&#37; eran fr&#225;giles con FPFI y un 17&#37; prefr&#225;giles&#44; y de los pacientes fr&#225;giles con FPFI un 60&#37; eran fr&#225;giles con EFS y un 40&#37; vulnerables o no fr&#225;giles&#46; El EFS clasificaba un mayor n&#250;mero de pacientes como no fr&#225;giles&#44; mientras que el FPFI clasificaba un mayor n&#250;mero como prefr&#225;giles&#46; Es dif&#237;cil valorar en un estudio transversal la raz&#243;n y las implicaciones pron&#243;sticas de esta discordancia en los resultados&#44; pero podr&#237;a deberse a las diferentes esferas de la fragilidad que se miden con cada uno de los test&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las principales caracter&#237;sticas demogr&#225;ficas&#44; cl&#237;nicas y anal&#237;ticas seg&#250;n los resultados de ambos test&#46; En dicha tabla puede observarse que existe una asociaci&#243;n entre fragilidad y otros datos cl&#237;nicos de mal pron&#243;stico&#44; como son la edad avanzada&#44; la presencia de diabetes mellitus&#44; un mayor &#237;ndice de comorbilidad de Charlson y el sexo femenino&#46; Entre los par&#225;metros anal&#237;ticos se observ&#243; una discreta disminuci&#243;n de hemoglobina&#44; alb&#250;mina y &#225;cido &#250;rico estad&#237;sticamente significativa en los grupos prefr&#225;giles y fr&#225;giles con respecto al de no fr&#225;giles&#46; No observamos diferencias en los par&#225;metros del metabolismo &#243;seo-mineral ni en el perfil lip&#237;dico entre los grupos&#46; Se observa un descenso significativo de la CPK con la fragilidad&#44; que podr&#237;a reflejar una disminuci&#243;n de la masa muscular por la sarcopenia asociada a la fragilidad&#46; Tambi&#233;n observamos un aumento de algunos par&#225;metros anal&#237;ticos que han sido descritos como marcadores de mal pron&#243;stico por su relaci&#243;n con la inflamaci&#243;n o con la sobrehidrataci&#243;n&#44; como la prote&#237;na C reactiva&#44; el NT-proBNP y la amplitud de distribuci&#243;n eritrocitaria&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">En el seguimiento a un a&#241;o se observ&#243; una mortalidad del 21&#44;1&#37; en los pacientes fr&#225;giles frente a un 11&#37; en los pacientes prefr&#225;giles y no fr&#225;giles con el FPFI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Se observ&#243; una mortalidad del 26&#44;8&#37; en los pacientes fr&#225;giles frente a un 10&#44;3&#37; en los pacientes vulnerables y no fr&#225;giles con el EFS &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; observamos una alta prevalencia de fragilidad en los pacientes en hemodi&#225;lisis&#46; La presencia de fragilidad se asocia a una mala evoluci&#243;n a corto plazo&#46; Sin embargo&#44; encontramos una falta de concordancia entre los test utilizados para mediar la fragilidad&#44; por lo que se hace necesario realizar m&#225;s estudios para validar los test de fragilidad en pacientes en hemodi&#225;lisis&#44; determinar su valor pron&#243;stico y establecer el impacto de las posibles medidas terap&#233;uticas para revertir la fragilidad en este grupo de pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">Este trabajo ha sido financiado en parte con una beca de la XXI convocatoria I<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>E del Colegio Oficial de M&#233;dicos de Las Palmas&#46;</p></span></span>"
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