Usefulness of frailty evaluation for handling chronic kidney disease elderly patients: a review and original proposal

  • Marco Ostuni
  • Carlos G. MussoEmail author
Nephrology - Review


There is interdependence between chronic kidney disease (CKD) and ageing whereby CKD makes ageing more accelerated and pronounced, whereas ageing accelerates chronic nephropathy’s progression. Frailty status catalyzes this spiral, with renal and systemic negative consequences, and this condition can currently be documented by applying already validated clinical scores (frailty phenotype) or physical test (gate speed). Although, nephroprevention strategies are similar between young adult and senior CKD patients, standard targets should be adequate to very old and frail elderly individuals. For this purpose, an original algorithm is here proposed to adjust the conventional nephroprevention strategies to the condition of CKD frail patient (more relaxed targets and tighter control), as well as to prescribe anti-frailty interventions to slow patient’s functional decline, hospitalization and mortality.


Chronic kidney disease Nephroprevention Elderly Frailty 


Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.


  1. 1.
    Rennke H, Denker B (1994) Renal pathophysiology. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  2. 2.
    Mora-Gutiérrez JM, Slon Roblero MF, Castaño Bilbao I, Izquierdo Bautista D, Arteaga Coloma J, Martínez Velilla N (2017) Chronic kidney disease in the elderly patient. Rev Esp Geriatr Gerontol 52:152–158CrossRefGoogle Scholar
  3. 3.
    Glassock R, Delanaye P, El Nahas M (2015) An age-calibrated classification of chronic kidney disease. JAMA 314:559–560CrossRefGoogle Scholar
  4. 4.
    Kojima G (2017) Prevalence of frailty in end-stage renal disease: a systematic review and meta-analyses. Int Urol Nephrol 49:1989–1997CrossRefGoogle Scholar
  5. 5.
    Musso CG, Jauregui JR, Macías Núñez JF (2015) Frailty phenotype and chronic kidney disease: a review of the literature. Int Urol Nephrol 47(11):1801–1807CrossRefGoogle Scholar
  6. 6.
    Roshanravan B, KhatriRoshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel KV, de Boer IH, Seliger S, Ruzinski J, Himmelfarb J (2012) Kestenbaum BA prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis 60(6):912–921. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Johansen KL, Delgado C, Bao Y, Kurella Tamura M (2013) Frailty and dialysis initiation. Semin Dial 26(6):690–696CrossRefGoogle Scholar
  8. 8.
    Rowe JW, Kahn RL (1987) Human aging: usual and successful. Science 237:143–149CrossRefGoogle Scholar
  9. 9.
    Chen X, Mao G, Leng S (2014) Frailty syndrome: an overview. Clin Interv Aging 9:433–441PubMedPubMedCentralGoogle Scholar
  10. 10.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A 56(3):M146–M156CrossRefGoogle Scholar
  11. 11.
    Jones DM, Song X, Rockwood K (2004) Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 52:1929–1933CrossRefGoogle Scholar
  12. 12.
    Walker SR, Gill K, Macdonald K, Komenda P, Rigatto C, Sood MM, Bohm CJ, Storsley LJ, Tangri N (2013) Association of frailty and physical function in patients with non-dialysis CKD: a systematic review. BMC Nephrol 14:228. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ayaz T, Sahin SB, Sahin OZ, Bilir O, Rakıcı H (2014) Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. J Aging Res 2014:584315CrossRefGoogle Scholar
  14. 14.
    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J (2011) Gait speed and survival in older adults. JAMA 305(1):50–58. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS (2012) Diabetes in older adults. Diabetes Care 35(12):2650–2664. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Shastri S, Katz R, Rifkin DE, Fried LF, Odden MC, Peralta CA, Chonchol M, Siscovick D, Shlipak MG, Newman AB, Sarnak MJ (2012) Kidney function and mortality in octogenarians: cardiovascular Health Study All Stars. J Am Geriatr Soc 60(7):1201–1207. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495CrossRefGoogle Scholar
  18. 18.
    Morley J, Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14(6):392–397. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kutner NG, Zhang R, Huang Y, Wasse H (2014) Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data. World J Nephrol 3:101–106CrossRefGoogle Scholar
  20. 20.
    Aiello F, Dueña E, Musso CG (2017) Senescent nephropathy: the new renal syndrome. Healthcare 5(4):E81. CrossRefPubMedGoogle Scholar
  21. 21.
    Tattersall J, Farrington K, Gentile G, Kooman J, Macias Núñez JF, Nistor I, Van Biesen W, Covic A, European Renal Best Practice Guidelines Group and the European Union of Geriatric Medicine Societies (EUGMS) (2018) Is Kt/V useful in elderly dialysis patients? Pro- and con arguments. Nephrol Dial Transplant. CrossRefPubMedGoogle Scholar
  22. 22.
    Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld C, McCulloch CE (2009) Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 361:1539–1547CrossRefGoogle Scholar
  23. 23.
    Huang Y, Zhang R, Culler SD, Kutner NG (2008) Costs and effectiveness of cardiac rehabilitation for dialysis patients following coronary bypass. Kidney Int 74:1079–1084CrossRefGoogle Scholar
  24. 24.
    Li M, Porter E, Lam R, Jassal SV (2007) Quality improvement through the introduction of interdisciplinary geriatric hemodialysis rehabilitation care. Am J Kidney Dis 50:90–97CrossRefGoogle Scholar
  25. 25.
    Swidler M (2009) Dialysis decisions in the elderly patient with advanced CKD and the role of non-dialytic therapy. In Geriatric nephrology curriculum. American Society of Nephrology, WashingtonGoogle Scholar
  26. 26.
    Musso CG, Vilas M, Onuigbo M (2015) Nephroprevention in the oldest old with chronic kidney disease: special considerations. World J Nephrol 4(1):1–5. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Physiology DepartmentInstituto Universitario del Hospital Italiano de Buenos AiresBuenos AiresArgentina
  2. 2.Ageing Biology UnitHospital Italiano de Buenos AiresBuenos AiresArgentina

Personalised recommendations