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Review
. 2021 Jun 9;6(9):2270-2280.
doi: 10.1016/j.ekir.2021.05.025. eCollection 2021 Sep.

Frailty in CKD and Transplantation

Elizabeth C Lorenz  1   2 , Cassie C Kennedy  2   3 , Andrew D Rule  1 , Nathan K LeBrasseur  4 , James L Kirkland  4 , LaTonya J Hickson  5
Affiliations
Review

Frailty in CKD and Transplantation

Elizabeth C Lorenz et al. Kidney Int Rep. .

Abstract

The population is aging. Although older adults have higher rates of comorbidities and adverse health events, they represent a heterogeneous group with different health trajectories. Frailty, a clinical syndrome of decreased physiological reserve and increased susceptibility to illness and death, has emerged as a potential risk stratification tool in older patients with chronic kidney disease (CKD). Frailty is commonly observed in patients with CKD and associated with numerous adverse outcomes, including falls, decreased quality of life, hospitalizations, and death. Multiple pathologic factors contribute to the development of frailty in patients with CKD, including biological mechanisms of aging and physiological dysregulation. Current interventions to reduce frailty are promising, but additional investigations are needed to determine whether optimizing frailty measures improves renal and overall health outcomes. This review of frailty in CKD examines frailty definitions, the impact of frailty on health outcomes across the CKD spectrum, mechanisms of frailty, and antifrailty interventions (e.g., exercise or senescent cell clearance) tested in CKD patients. In addition, existing knowledge gaps, limitations of current frailty definitions in CKD, and challenges surrounding effective antifrailty strategies in CKD are considered.

Keywords: aging; cellular senescence; chronic kidney disease; frailty; kidney transplantation; physical activity.

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Figures

Figure 1
Figure 1
Adverse outcomes associated with frailty and chronic kidney disease.
Figure 2
Figure 2
Frailty pathogenesis in chronic kidney disease.
Figure 3
Figure 3
Components of promising antifrailty interventions in chronic kidney disease.
See this image and copyright information in PMC

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