Traditional dietary recommendations to renal patients limited the intake of fruits and vegetables because of their high potassium content. However, this paradigm is rapidly changing due to the multiple benefits derived from a fundamentally vegetarian diet such as, improvement in gut dysbiosis, reducing the number of pathobionts and protein-fermenting species leading to a decreased production of the most harmful uremic toxins, while the high fiber content of these diets enhances intestinal motility and short-chain fatty acid production. Metabolic acidosis in chronic kidney disease (CKD) is aggravated by the high consumption of meat and refined cereals, increasing the dietary acid load, while the intake of fruit and vegetables is able to neutralize the acidosis and its deleterious consequences. Phosphorus absorption and bioavailability is also lower in a vegetarian diet, reducing hyperphosphatemia, a known cause of cardiovascular mortality in CKD. The richness of multiple plants in magnesium and vitamin K avoids their deficiency, which is common in these patients. These beneficial effects, together with the reduction of inflammation and oxidative stress observed with these diets, may explain the reduction in renal patients’ complications and mortality, and may slow CKD progression. Finally, although hyperkalemia is the main concern of these diets, the use of adequate cooking techniques can minimize the amount absorbed.

Background: Frailty among older adults undergoing hemodialysis is increasingly prevalent, significantly impacting cognitive function, mobility, and social engagement. This study focuses on the clinical profiles of very older adults in hemodialysis, particularly examining the interplay of dependency and frailty, and their influence on dialysis regimens. Methods: In this observational, descriptive study, 107 patients aged over 75 from four outpatient centers and one hospital unit were examined over a year. Patient data encompassed sociodemographic factors, dialysis specifics, analytical outcomes, lifestyle elements, and self-reported post-treatment fatigue. Malnutrition-inflammation scale was used to measure the Nutritional status; MIS scale for malnutrition-inflammation, Barthel index for dependency, Charlson comorbidity index; FRIED scale for frailty and the SF12 quality of life measure. Results: The study unveiled that a substantial number of older adults on hemodialysis faced malnutrition (55%), dependency (21%), frailty (46%), and diminished quality of life (57%). Patients with dependency were distinctively marked by higher comorbidity, severe malnutrition, enhanced frailty, nursing home residency, dependency on ambulance transportation, and significantly limited mobility, with 77% unable to walk. Notably, 56% of participants experienced considerable post-dialysis fatigue, correlating with higher comorbidity, increased dependency, and poorer quality of life. Despite varying clinical conditions, dialysis patterns were consistent across the patient cohort. Conclusions: The older adult cohort, averaging over four years on hemodialysis, exhibited high rates of comorbidity, frailty, and dependency, necessitating substantial support in transport and living arrangements. A third of these patients lacked residual urine output, yet their dialysis regimen mirrored those with preserved output. The study underscores the imperative for tailored therapeutic strategies to mitigate dependency, preserve residual renal function, and alleviate post-dialysis fatigue, ultimately enhancing the physical quality of life for these patients.

Background: In elderly haemodialysis patients, poor functional status correlates with malnutrition, morbidity and mortality. This study aimed to assess 1‐year survival in an elderly haemodialysis population and evaluate the predictive capacity of commonly used scales for comorbidity, malnutrition, dependence and frailty. Methods: We conducted a 1‐year observational study (2022) on prevalent haemodialysis patients aged > 75 years with > 3 months of treatment. Mortality was assessed during the follow‐up. We analysed sociodemographic, dialysis‐related, analytical and lifestyle variables. Additionally, we evaluated comorbidity (Charlson), dependence (Barthel), malnutrition‐inflammation (MIS scale) and frailty (FRIED). Statistical analysis included comparisons between continuous variables using the Mann–Whitney U test or Student's t test, based on normality distribution. Categorical variables were compared using the chi‐square test. Kaplan–Meier survival analysis with log‐rank test was used to compare survival curves. Multivariate analysis was performed using Cox proportional hazards models, adjusting for confounders including dialysis adequacy and underlying kidney disease aetiology. Optimal cutoff points for predicting mortality were determined using receiver operating characteristic (ROC) curves. Results: A total of 107 haemodialysis patients (57% male, mean age 81.3 ± 4.53 years, mean time on haemodialysis 51.71 ± 51.04 months) were included. Sixteen patients (15%) died within 1 year. Deceased patients were older (83.94 ± 4.52 vs. 80.34 ± 4.39 years, p = 0.011) and had longer dialysis duration (76.46 ± 54.73 vs. 47.35 ± 49.4 months, p = 0.035), lower albumin (3.51 ± 0.54 vs. 3.86 ± 0.31 g/dL, p < 0.001) and lower creatinine levels (5.48 ± 1.12 vs. 6.50 ± 1.67 mg/dL, p = 0.021). They scored higher on all four scales analysed: Charlson (10.94 ± 1.81 vs. 8.95 ± 1.92, p < 0.001), MIS (11.31 ± 4.22 vs. 6.07 ± 3.27, p < 0.001), Barthel (52.50 ± 27.2 vs. 78.41 ± 23.11, p < 0.001), and FRIED (3.19 ± 1.05 vs. 2.18 ± 1.32, p = 0.005). Institutionalization ( p = 0.004), inability to walk ( p < 0.001) and stretcher transport ( p < 0.001) were also significantly associated with mortality. The optimal cutoff points for predicting mortality were Charlson index ≥ 9.5 (AUC 0.788, 95% CI: 0.65–0.88), MIS ≥ 7.5 (AUC 0.844, 95% CI: 0.73–0.93), Barthel ≤ 67.5 (AUC 0.79, 95% CI: 0.68–0.79) and FRIED ≥ 2.5 (AUC 0.719, 95% CI: 0.56–0.83). In multivariable analysis, Charlson ≥ 9.5 (HR 2.75, 95% CI: 0.83–9.06, p = 0.096) and MIS ≥ 7.5 (HR 8.15, 95% CI: 1.10–60.58, p = 0.040) remained significant predictors of mortality. Conclusions: The Charlson, Barthel, MIS and FRIED scales are useful tools for predicting mortality in elderly haemodialysis patients, with defined cutoff points for increased mortality risk. We have defined specific cutoff points that determine increased mortality risk in this population. However, comorbidity and malnutrition showed the strongest independent predictive value. These findings highlight the need for targeted interventions to address malnutrition and comorbidity in this vulnerable population.