#4818 impact of combined physical frailty and depressive symptoms on mortality in patients on hemodialysis

Abstract Background and Aims Patients receiving hemodialysis [HD] are getting older, with 38.8% of patients in Japan being 75 years or older. HD patients also have multiple comorbidities, which are known to be associated with poor clinical outcomes, especially in the older patients. Moreover, physical frailty and depressive symptoms are common in HD patients and these are known to be risk factors for poor prognosis. However, it is unclear whether the coexistence of physical frailty and depressive symptoms contributes to an increased risk of mortality in older patients with multiple comorbidities. As a result, the goal of this study was to look at the relationship between physical frailty and depressive symptoms and mortality in HD patients of different ages. Method This study included 409 Japanese outpatients with HD (mean age 65.9 years, 62.6% male, and 2.0 years of hemodialysis history). Slow walking speed and/or weak hand grip strength were used to define physical frailty. The Center for Epidemiological Studies-Depression scale was used to assess depressive symptoms. Patients were divided into four groups: (1) no depressive symptoms, no physical frailty; (2) depressive symptoms, no physical frailty; (3) no depressive symptoms, physical frailty; and (4) depressive symptoms, physical frailty. All-cause mortality was the outcome; Cox regression analysis was performed, with analysis stratified by age group (<75 years, ≥75 years) to examine differences by age. Results Physical frailty and depressive symptoms were prevalent in 268 (65.5%) and 143 (35.0%) of the population, respectively. Physical frailty and depressive were present in 103 people (25.2%). 129 (31.5%) people died during the follow-up period (median 49 months). In all patients, Cox regression analysis revealed that physical frailty and no depressive symptoms (hazard ratio [HR], 1.86, 95% confidence interval [CI], 1.01–3.44) and coexistence of physical frailty and depressive symptoms (HR, 2.30, 95% CI, 1.23–4.28) were significantly associated with an increased risk of death. In the <75-year-old group, a combination of physical frailty and depressive symptoms was significantly associated with an increased risk of death (HR, 2.45; 95% CI, 1.23–4.88). In the ≥75-year-old group, however combined physical frailty and depressive symptoms were not significantly associated with mortality (HR, 2.06; 95% CI, 0.34–12.55), whereas C-reactive protein was (HR, 1.59; 95% CI, 1.10–2.28). Conclusion Physical frailty and depressive symptoms were common in HD patients. In terms of prognosis, the coexistence of physical frailty and depressive symptoms were linked to mortality in the <75-year-old group, whereas in the <75-year-old group, the coexistence of physical frailty and depressive symptoms was not associated with death, but higher inflammation was associated.