Frailty and chronic kidney disease: current evidence and continuing uncertainties

Abstract

Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.

Diagnostic Accuracy of Frailty Screening Methods in Advanced Chronic Kidney Disease

“…However, there was no significant difference in vitamin D level between non-frail and frail groups in this cohort of CKD patients. These findings may be explained by the pathogenesis of frailty in CKD being distinct from the general older population, with factors such as the accumulation of uraemic toxins, reduced appetite, metabolic acidosis and anabolic hormone dysregulation contributing more prominently [2,18]. Walking speed, hand grip strength and the SPPB have all been proposed as frailty screening measures [17,24,25,45,46].…”

“…A convenience series of participants was recruited from Lancashire Teaching Hospitals NHS Foundation Trust between December 2016 and December 2017 from nephrology outpatient clinics and 2 Haemodialysis Units. Though there are distinctions between patients that are pre-dialysis and dialysis-dependent, the drivers of frailty are similar, and the clinical expression of frailty is comparable [18]. Therefore, patients ≥18 years old with CKD G4-5 and CKD G5D were eligible for participation in the study.…”

Composite Uremic Load and Physical Performance in Hemodialysis Patients: A Cross-Sectional Study

“…The uremic syndrome is a multifactorial condition affecting the inflammatory, CV, and neural systems [8]. Comorbidities related to these systems, such as malnutrition, CV disease, neuropathy, and frailty also contribute to impaired physical performance in patients with end-stage kidney disease [29]. Next to solute removal, aspects of dialysis that contribute to malnutrition and inflammation will therefore have an impact on physical performance as well.…”

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

“…Therefore, our results suggest that it may be necessary to use a combination of the PhA and hs-CRP levels when testing models that predict sarcopenia, frailty, and/or mortality. Chronic inflammatory conditions, which are common in patients with DMCKD, have been recognized as a major contributor to cardiovascular disease, protein energy wasting, osteoporosis, sarcopenia, and frailty [25][26][27].…”