The Frail Dialysis Population: A Growing Burden for the Dialysis Community.

BACKGROUND: The dialysis population is aging worldwide. It is well known that patients on dialysis have limited functional status, but only recently has frailty been considered.
SUMMARY: The prevalence of frailty among patients on dialysis ranges from 3.4- to 10-fold higher than among community-dwelling elderly, depending on the method of assessing frailty and patient characteristics. Despite its high prevalence and the high overall mortality in the dialysis population, frailty is associated with higher mortality, independent of clinical and demographic characteristics and comorbidity. The prevalence of frailty among patients with non-dialysis-dependent chronic kidney disease (CKD) is also high, and cross-sectional data suggest that the prevalence may increase as CKD progresses. Thus, interventions to improve frailty have the potential to improve quality of life and mortality. Although interventions to improve physical dysfunction have been successful in the population with end-stage renal disease, no studies have specifically targeted frail individuals. Therefore, the extent to which exercise or physical activity interventions are feasible among frail patients and can improve frailty urgently needs to be examined. In the meantime, providers should refer frail patients to physical therapists and encourage them to be more active if possible. In addition, more attention should be focused on the possibility that rehabilitation among patients with earlier stages of CKD could improve dialysis outcomes. KEY MESSAGES: Frailty is extremely common among patients on dialysis and is independently associated with adverse outcomes. Providers should take advantage of available resources to improve functioning in this population, and research should address the optimal strategy for addressing frailty, including timing of intervention.