Frailty and chronic kidney disease: associations and implications / Fragilidade e doença renal crônica: associações e implicações

ABSTRACT Introduction: Frailty and its association with chronic kidney disease (CKD) has been established previously. The present study examined this association further by studying the distribution of frailty among groups defined by different stages of the disease. It also identified associated health deficits and explored their association with estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). Methods: A cross-sectional survey was conducted on 90 non-dialysis dependent CKD Stage 1-4 patients, recruited in three stratified groups of 30 participants each based on the stage of disease. Frailty was assessed using Fried's frailty criteria and associated health deficits were recorded using a pre-determined list. Depression was screened using a 4-point depression scale. Results: 21.1% of the participants were frail and 43.3% were pre-frail. The proportion of frailty in CKD groups A (Stages 1 and 2), B (Stage 3a), and C (Stages 3b and 4) was 10%, 13.3%, and 40%, respectively. The association of health deficits including co-morbidities, physical parameters, mental status, daily activities, etc. with UACR, eGFR, and CKD stages was not statistically significant. Nearly one in two frail participants was depressed compared with 14% among non-frail participants. Conclusion: The skewed distribution of 21% frail subjects identified in our study indicates an association between frailty and advancing kidney disease. Frail individuals had a lower eGFR, higher UACR, were more likely to be depressed, and had higher count of health deficits and poorer performance on Barthel Index of Activities of Daily Living and WHOQOL. Early identification of depression would improve care in these patients.

RESUMO Introdução: Fragilidade e sua associação com DRC foram estabelecidas anteriormente. O presente estudo aprofundou esta associação, estudando distribuição da fragilidade entre grupos definidos por diferentes estágios da doença. Também identificou déficits de saúde associados e explorou sua associação com taxa de filtração glomerular estimada (TFGe) e relação albumina/creatinina urinária (RAC). Métodos: Realizou-se uma pesquisa transversal em 90 pacientes com DRC Estágios 1-4 não dependentes de diálise, recrutados em três grupos estratificados de 30 participantes cada, conforme estágio da doença. Avaliou-se fragilidade usando os critérios de fragilidade de Fried e registraram-se os déficits de saúde associados usando uma lista pré-determinada. A depressão foi verificada utilizando a escala de depressão de 4 pontos. Resultados: 21,1% dos participantes eram frágeis e 43,3% eram pré-frágeis. A proporção de fragilidade nos grupos de DRC A (Estágios 1 e 2), B (Estágio 3a), e C (Estágios 3b e 4) foi de 10%, 13,3%, 40% respectivamente. A associação de déficits de saúde, incluindo comorbidades, parâmetros físicos, estado mental, atividades diárias etc. com RAC, TFGe e estágios da DRC não foi estatisticamente significativa. Cerca de um em cada dois participantes frágeis estava depressivo comparados com 14% entre não frágeis. Conclusão: A distribuição enviesada de 21% dos indivíduos frágeis identificados em nosso estudo indica associação entre fragilidade e doença renal progressiva. Indivíduos frágeis apresentaram menor TFGe, maior RAC, eram mais propensos a depressão, tinham maior índice de déficits de saúde e desempenho inferior no Índice de Atividades da Vida Diária de Barthel e WHOQOL. A identificação precoce da depressão melhoraria o atendimento desses pacientes.

Variation in COVID Mortality with Different Demographic Factors in Districts of India

Background : Descriptive data suggests significant disparity in the COVID-19 related deaths across different demographic zones. Several studies have examined these factors at the intra-country or intrastate level. Our study analyzed the data at a District level. Methods : This cross-sectional study analyzed the association between Socio-demographic factors and COVID19 Mortality at a District level using Univariate and Multivariate linear regression models. Data for sixty randomly selected Districts was collected and compiled from free sources available in the public domain. Linear regression models were built and factors that were found to be significant were used in the model. Results : Univariate analysis revealed that COVID Mortality has a positive correlation with the literacy rate and a negative correlation with the percentage Rural population of the District. No significant relation was found with primary Health Center accessibility, Sex Ratio and the percentage of chronic illness. On Multivariate analysis, it was negatively correlated to only the percentage of the Rural population. Conclusion and Relevance : Our study concluded that as the rural population increased in a district, COVID 19 mortality decreased. There was no significant association with other sociodemographic variables.

Lessons from the Pandemic and Healthcare Service Delivery for the Senior Citizens

Background : The healthcare delivery system is an important indicator of the quality of life in a society. The advent of the Corona Virus pandemic led to an unfortunate and unforeseen disruption in the healthcare services Globally. The older persons were impacted on multiple counts including limitations in healthcare service availability, access and social marginalization. As we gain more insight into the full impact of the Pandemic on the health quality indicators and look to resume Medical service delivery in Postpandemic times, it’s important to ensure that the older population is not neglected. Discussions : Small transitions in the delivery models but larger modifications in the mind-set may be needed to provide continued, effective and seamless healthcare services to the older Indian population. Planned interventions at each level of the system can ensure a smooth transition into the modified systems. Integration of modern telecommunication technology into the medical practice and extensive research in the area can make telemedicine a more accessible and acceptable option to the elderly patients with chronic ailments. The full extent of the impact of the Pandemic on healthcare will be revealed in the coming times requiring constant adaptation of each element of the system to cope with it.