Frailty and mortality among dialysis patients

Abstract

Frailty is a clinical state in which there is an increase in the individual's vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Since the mean age of dialysis patients is increasing worldwide, frailty has recently come to be considered one of the risk factors for mortality in the older dialysis population. The prevalence of frailty among dialysis patients has ranged from 3.0-to 10-fold higher than that among community-dwelling elderly, depending on the method of assessing frailty and patient characteristics. Since frailty has been found to be associated with higher mortality, independent of clinical characteristics and comorbidity, interventions to improve frailty have the potential to contribute to better quality of life and lower mortality among dialysis patients. In addition, greater attention should be focused on the possibility that early rehabilitation of dialysis patients might improve poor outcomes. Clinical research should aim to devise an adequate strategy to address frailty, including identifying the optimal timing for intervention.

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

“…This result was consistent with recent studies showing a close correlation between frailty and aging [ 49 , 50 ]. Aging causes conditions such as chronic diseases, depressive symptoms, and declined cognitive and functional capacity, and aging increases the likelihood of developing frailty [ 51 ]. Particularly, ESRD may accelerate the aging process in patients due to uremic toxins, inflammations, protein energy waste, and oxidative stress [ 52 ].…”

The Impact of the Glomerular Filtration Rate on the Human Plasma Proteome

“…As renal function declines, the filtration of water‐soluble molecules with a molecular mass of <50 kDa decreases, leading to subsequent accumulation of proteins in the blood. Simultaneously, impairment of kidney function may be associated with altered protein synthesis, with diminished erythropoietin as a well‐known example . Thus, CKD progression may lead to both an increase and decrease in plasma proteins levels.…”

“…Simultaneously, impairment of kidney function may be associated with altered protein synthesis, with diminished erythropoietin as a well-known example. [5] Thus, CKD progression may lead to both an increase and decrease in plasma proteins levels.…”

Differences in the performance of adjuvant chemotherapy between hemodialysis and nonhemodialysis patients

“…First, we did not have information concerning the patient's general condition, such as performance status and comorbidity. The prevalence of frailty among HD patients is higher than among non‐HD patients, 24 which may be a reason for not administering chemotherapy. However, since our patients were all sufficiently fit to undergo curative surgery, preexisting comorbidities could not fully explain the large difference between HD and non‐HD patients.…”