Ertuğrul ERKEN, Fatma Betül GÜZEL, Gülsüö AKKUŞ, Özkan GÜNGÖR, Orçun ALTINÖREN

GENÇ ERİŞKİN HEMODİYALİZ HASTALARINDA KIRILGANLIK VE KOGNİTİF BOZUKLUK ARASINDAKİ İLİŞKİ

Amaç: Kırılganlık; geriyatrik popülasyonlarda oluşturulmuş, fiziksel inaktiviteyi ve hastalık komplikasyonlarına duyarlılığı anlatan bir tanımlamadır. Hemodiyaliz (HD) hastalarında kırılganlığı inceleyen çalışmaların çoğu yaşlı popülasyonlardadır. Kognitif bozukluk HD hastalarının göz ardı edilen bir sorunudur. Bu çalışmanın amacı genç erişkin HD hastalarında kırılganlıkla kognitif bozukluk arasındaki ilişkiyi araştırmaktır. Yöntemler: Çalışmaya 18-65 yaş arası 102 HD hastası alındı. Kırılganlık; klinik kırılganlık indeksi (KKİ) ile, kognitif durum Montreal Cognitive Assesment (MoCA) ile değerlendirildi. KKİ puanı 5-7 arası olan hastalar kırılgan, 4-7 arası olanlar duyarlı-veya-kırılgan olarak belirlendi. MoCA skoru <24/30 olanlar kognitif bozukluk olarak değerlendirildi. Bulgular: Hastaların yaş ortalaması 48,3±12,4 yıl idi. Duyarlı-veya-kırılgan olma %26,7, kırılganlık %12,7 sıklıkta bulundu. Kognitif bozukluk sıklığı %69,6 idi. Kognitif bozukluğu olan ve olmayan HD hastaları karşılaştırıldığında, kognitif bozukluğu olanlarda hem kırılgan olma sıklığı hem de duyalı-veya-kırılgan olma sıklığı anlamlı düzeyde artmıştı (sırasıyla %22,4; %0,0 p=0,011 ve %57,7; %3,3 p<0,001). KKİ puanı ile MoCA skoru arasında anlamlı negatif korelasyon vardı (-r=0,607, p<0,001). Bu korelasyon yaş, diyabetes mellitus ve kardiyovasküler hastalıkla yapılan regresyon analizinden sonra anlamlılığını korudu (p=0,012). Sonuç: Bu çalışma genç erişkin HD hastalarında kırılganlığın kognitif bozukluk ile ilişkili olabileceğini gösterdi. HD hastalarında kırılganlığın belirlenmesi, inaktivite ve komorbiditeler dışında, kognitif bozukluğa karşı da önlem almamızı gerektirebilir.

Anahtar Kelimeler:

Kırılganlık, kognitif bozukluk, hemodiyaliz

THE RELATIONSHIP BETWEEN FRAILTY AND COGNITIVE IMPAIRMENT IN YOUNG ADULT HEMODIALYSIS PATIENTS

Objective: Frailty is a definition used in relation to geriatric populations, indicating physical inactivity and susceptibility to disease. Studies investigating frailty in hemodialysis (HD) patients mostly include the elderly. Cognitive impairment is overlooked in HD patients. This study aims to investigate associations between frailty and cognitive impairment in young-adult HD patients. Methods: The study included 102 HD patients aged 18-65 years old. Frailty was evaluated using the clinical frailty index (CFI) and cognition was evaluated using the Montreal Cognitive Assessment (MoCA). A CFI value between 5 and 7 was defined as frail, and 4-7 was defined as vulnerable-or-frail. An MoCA value <24/30 was determined as cognitive impairment. Results: Mean patient age was 48.3±12.4 years. Vulnerable-or-frail patients accounted for 26.7%, frailty, 12.7%. Frequency of cognitive impairment was 69.6%. The likelihood of Frailty and being vulnerable-or-frail were increased in patients with cognitive impairment compared with those without cognitive impairment (22.4%; 0.0% p=0,011 and 57.7%; 3,3% p<0,001). CFI and MoCA were negatively correlated (-r=0,607, p<0.001), which was still significant after adjusting for age, diabetes mellitus and cardiovascular disease (p=0.012). Conclusion: This study showed that frailty may be associated with cognitive impairment in young-adult HD patients. Determining frail HD patients may necessitate dealing with inactivity, comorbidities and also cognitive impairment.

Keywords:

Frailty, cognitive impairment, hemodialysis,

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