P0957DISABILITY OF DIALYSIS PATIENTS AND CONDITION OF THEIR BLOOD VESSELS
Authors: Gołębiowski Tomasz , Ada Gawryś , Krzysztof Letachowicz , Beata Skolimowska , Bożena Ostrowska , Andrzej Konieczny , Piotr Olczyk , Magdalena Krajewska , Mariusz Kusztal 
Published: June 2020

Background and Aims

Epidemiological data indicate constant increase of mean age among hemodialysis patients. These population have high burden of comorbid conditions, including cardiovascular (CV) diseases, which lead to disability and the need for continuous care. The aim of the study was to analyze the problems of disability in hemodialysis patients in the context of cardiovascular complication and vascular condition.

Method

In this cross-sectional study 129 patients (mean age 64.5 y, 54 females, with mean dialysis vintage 61 months) were enrolled from 3 satellite dialysis centers (inclusion criteria: age ≥18 y, dialysis vintage≥3 months). Demographic and comorbidity data were collected from medical records and during interview. The degree of disability (Bartel scale), 10-year cardiovascular risk (QRISK®3 online calculator), degree of imbalance (questionnaire - Falls Efficacy Scale – International (FES-I)) were assessed.

In addition, ambulatory measurements of hemodynamic parameters with Mobil-O-Graph monitor (IEM, Stolberg,Germany), which records oscillometric arm blood pressure (SBP and DBP), central systolic (cSBP) and diastolic (cDBP), pulse pressure (pPP), ejection fraktion - (EF), cardiac output - (CO) and pulse waves. It calculates augmentation index (AIx@75) as measure of wave reflections, and pulse wave velocity (PWV) as measure of arterial stiffness.

Results

The most common causes of renal failure in the study group were ischemic - 35%, and diabetic nephropathy 26% (Fig. 1). Only 8 out of 129 pts. (6.2%) were professionally active, 40 (31%) received disability pension and 81 (62.8%) retirement. 25 (19%) used a wheelchair for transport and 21 (16%) used crutch. More than half (51%) were independent in everyday activities reaching 80-100 points on the Bartel scale, however only 14% were fully independent (100 points). Minimally dependent (60-79 points) constituted 27% (35 pts) of all patients, partially dependent (40-59 points) - 10% (13 pts), highly dependent (20-39 points) - 7% (9 pts) and fully dependent (&lt;20 points) 5% (6 pts). The most common causes of disability were heart problems, including heart failure in 20.9%, lower limb ischemia, diabetic foot and amputation in 13.1% and cerebrovascular event in 10.8% followed by weakness associated with dialysis and degenerative joints disease (Fig. 2). Less disable group (80-100 points on the Bartel scale) showed significantly lower PWV, lower QRISK®3 and FES I index compared to the non self-reliant group (Fig 3). The degree of disability according to Bartel scale negatively correlated with age, PWV, QRISK®3 and FES I index (Fig 4).

Conclusion

Our results indicate that half of the population of hemodialysis patients show some degree of functional dependence. The group of patients with higher degree of disability are older and characterize of the more advanced changes in the arteries, higher risk of the CV incidents and increase risk of fall.