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Frailty and chronic kidney disease: Current evidence and continuing uncertainties

Nixon, AC, Bampouras, TM, Pendleton, N, Woywodt, A, Mitra, S and Dhaygude, A (2017) Frailty and chronic kidney disease: Current evidence and continuing uncertainties. Clinical Kidney Journal, 11 (2). pp. 236-245. ISSN 2048-8505

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Open Access URL: https://doi.org/10.1093/ckj/sfx134 (Published version)


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.

Item Type: Article
Uncontrolled Keywords: CKD; dialysis; elderly; exercise; frailty; nutrition
Subjects: Q Science > QH Natural history > QH301 Biology
Q Science > QP Physiology
R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Oxford University Press (OUP)
SWORD Depositor: A Symplectic
Date Deposited: 01 Feb 2023 12:48
Last Modified: 01 Feb 2023 12:48
DOI or ID number: 10.1093/ckj/sfx134
URI: https://researchonline.ljmu.ac.uk/id/eprint/18784
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