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Frailty phenotype and chronic kidney disease: a review of the literature

  • Nephrology - Review
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Abstract

Frailty is a construct originally coined by gerontologists to describe cumulative declines across multiple physiological systems that occur with aging and lead individuals to a state of diminished physiological reserve and increased vulnerability to stressors. Fried et al. provided a standardized definition for frailty, and they created the concept of frailty phenotype which incorporates disturbances across interrelated domains (shrinking, weakness, poor endurance and energy, slowness, and low physical activity level) to indentify old people who are at risk of disability, falls, institutionalization, hospitalization, and premature death. Some authors consider the presence of lean mass reduction (sarcopenia) as part of the frailty phenotype. The frailty status has been documented in 7 % of elderly population and 14 % of not requiring dialysis CKD adult patients. Sarcopenia increases progressively along with loss of renal function in CKD patients and is high in dialysis population. It has been documented that prevalence of frailty in hemodialysis adult patients is around 42 % (35 % in young and 50 % in elderly), having a 2.60-fold higher risk of mortality and 1.43-fold higher number of hospitalization, independent of age, comorbidity, and disability. The Clinical Frailty Scale is the simplest and clinically useful and validated tool for doing a frailty phenotype, while the diagnosis of sarcopenia is based on muscle mass assessment by body imaging techniques, bioimpedance analysis, and muscle strength evaluated with a handheld dynamometer. Frailty treatment can be based on different strategies, such as exercise, nutritional interventions, drugs, vitamins, and antioxidant agents. Finally, palliative care is a very important alternative for very frail and sick patients. In conclusion, since the diagnosis and treatment of frailty and sarcopenia is crucial in geriatrics and all CKD patients, it would be very important to incorporate these evaluations in pre-dialysis, peritoneal dialysis, hemodialysis, and kidney transplant patients in order to detect and consequently treat the frailty phenotype in these groups.

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Authors and Affiliations

  1. Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Carlos G. Musso & Jose R. Jauregui

  2. Nephrology Division, Hospital Universitario de Salamanca, Salamanca, Spain

    Juan F. Macías Núñez

Authors
  1. Carlos G. Musso
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  2. Jose R. Jauregui
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  3. Juan F. Macías Núñez
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Corresponding author

Correspondence to Carlos G. Musso.

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Appendix

Appendix

Frailty phenotype domains Fried et al. [7]

  • Shrinking: ≥10 pound (4.5 kg) of unintentionally weight loss in prior year.

  • Weakness: Grip strength in the lowest 20 % at baseline, adjusted to gender and body mass index.

  • Poor endurance and energy: Self-report exhaustion.

  • Slowness: Walking time/15 feet (4.5 m)—slowest 20 % The slowest 20 %, adjusting to gender and standing height.

  • Low physical activity level: Kilocalories (Kcals) expended per week—lowest 20 %.

Male: <383 Kcals/week.

Female: <270 Kcals/week.

Comorbidity Fried et al. [7]

Presence of 4 or more of the following conditions: peripheral vascular disease, rheumatoid arthritis, cancer, hypertension, chronic obstructive pulmonary disease, diabetes, congestive heart failure, angina, and myocardial infarction.

Disability Fried et al. [7, 47]

Inability to perform at least 2 of the following domains without assistance: feeding, dressing, ambulation, grooming, using a toilet, and bathing.

Clinical frailty scale [13, 43]

Very fit

People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age

Well

People who have no active disease, symptoms but are less fit than category 1. Often, they exercise or are very active occasionally

Managing well

People whose medical problems are well controlled, but are not regularly active beyond routine walking

Vulnerable

While not dependent on others for daily help, often symptoms limit activities. A common complaint is being “slowed up”, and/or being tired during the day

Mildly frail

These people often have more evident slowing and need help in high orders (finances, medication, transportation, heavy housework)

Moderately frail

People need help with all outdoor activities. Indoors they need help with housekeeping, and often have problems with stairs. They also need help with bathing and might need minimal assistance with dressing

Severely frail

Completely dependent for personal care, from either cause (physical or cognitive). Even so, they seem stable and not at high risk of dying

Very Severely frail

Completely dependent, and approaching the end of life (within 6 months)

Terminally ill

Approaching the end of life. This category applies to any people with a life expectancy <6 months, who are not otherwise evidently frail

If dementia is present, the degree of frailty usually corresponds to the degree of dementia

  • Mild dementia: includes forgetting the details of a recent events though still remembering the event itself, repeating the same question/story and social withdrawal

  • Moderate dementia: recent memory is very impaired, even though they seemingly can remember their past life events well. They can do personal care with prompting

  • Severe dementia: they cannot do personal care without help

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Musso, C.G., Jauregui, J.R. & Macías Núñez, J.F. Frailty phenotype and chronic kidney disease: a review of the literature. Int Urol Nephrol 47, 1801–1807 (2015). https://doi.org/10.1007/s11255-015-1112-z

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