Frailty in Non-Dialysis ChronicKidney Disease

Frailty status is a condition which is not merely induced by aging but mainly by a progressive and sustained deterioration of several body physiological processes that lead to an increased vulnerability to stressors. The prevalence of frailty is higher in older individuals with chronic kidney disease (CKD) compared to older people with normal renal function. Frailty prevalence increases with a worsened kidney function, which leads to an increase in falls, hospitalization, dialysis requirement, and mortality. CKD predisposes to frailty through many mechanisms, which can also lead to CKD progression. The coexistence of CKD and frailty phenotype has been considered a particular condition known as “senescent nephropathy,” since it is characterized by significant clinical complications, therapeutic demands, and worse prognosis, in comparison with robust older CKD patients. Frailty status trends should be identified since they represent an opportunity to successfully intervene by optimizing nutritional and rehabilitation efforts. The prevention or delay of the appearance of frailty and sarcopenia can be accomplished by low intensity resistance and aerobic physical exercise, caloric and protein intake, vitamin D supplementation, and avoidance of polypharmacy. In addition, these patients should also receive their corresponding CKD treatment, but even frailty evaluation can contribute to redesign the patient’s therapeutic objectives.