Tuscany Network Program for Evaluation of Functional Status in Hemodialysis: The Rehabilitation in Hemodialysis Area Centro Tuscany (REACT) Study

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Background: Frailty is associated with adverse outcomes among hemodialysis patients. Hemodialysis sessions may represent an opportunity to reassess functional status, to plan and monitor long-term physical exercise, leading to considerable improvement of quality of life and physical performance. The objective of our study is to assess the prevalence and predictors of frailty among a cohort of prevalent dialysis patients in our area (REACT Study). Methods: A regional program was designed to evaluate functional status in all patients performing hemodialysis in the 11 Dialysis Units of USL Toscana Centro. All patients are screened through the following tests: Short Form Health Survey (SF12); Elderly Falls Screening Test; Short Physical Performance Battery (SPPB); Handgrip test. Patients were assigned to three groups on the basis of the SPPB score: poor (SPPB <6), moderate (SPPB 7-9) and good performers (SPPB >9). Results: Of the 920 hemodialysis patients assessed for eligibility, 446 were enrolled and divided in 3 groups on the basis of SPPB score. Characteristics of the participants and functional status evaluation are shown in Table 1. SPPB score shows a significant correlation with handgrip of right arm (r=.248, p<0.001), with handgrip of left arm (r=.211, p<0.001), with Elderly Falls Screening Test (r=.448, p<0.001), with SF12 physical component (r=.432, p<0.001), with SF12 mental component (r=.146, p<0.001). Principal predictors of SPPB score are Elderly Falls Screening Test (adjusted R2=.235), and age (cumulative adjusted R2=.361).Table 1Conclusions: In our hemodialysis population, SPPB allowed identification of 3 frailty phenotypes. The information needed to determine patients' degree of frailty can be gathered relatively easily, making frailty assessment a routine activity in hemodialysis patients' evaluation.

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