La fragilidad en el anciano con enfermedad renal crónica

Abstract

In recent years, the concept of frailty as a "state of pre-disability" has been widely accepted by those involved in the care of the elderly. Its importance lies not only in its high prevalence - more than 25% in people over 85 years of age - but it is also considered an independent risk factor of disability, institutionalisation and mortality amongst the elderly. The study of renal function is relevant in patients with major comorbidities. Studies have shown a significant association between chronic kidney disease and the development of adverse clinical outcomes such as heart disease, heart failure, end-stage renal disease, increased susceptibility to infections and greater functional impairment. Frailty can be reversed, which is why a study of frailty in patients with chronic kidney disease is of particular interest. This article aims to describe the association between ageing, frailty and chronic kidney disease in light of the most recent and relevant scientific publications.

The Relationship between Physical Activity Levels and Functional Capacity in Patients with Advanced Chronic Kidney Disease

“…This study shows, for the first time, that the physical activity level HAP questionnaire results can be used to discriminate both HD and PD patients with greater or lesser functional capacity. Given the difficulty of assessing CKD patients outside of their normal clinical routine, it is very useful to have a tool that can be easily administered while they are receiving HD or being attended in a primary care consultation to screen for those with a high risk of fragility (Johansen et al, 2013;Portilla Franco et al, 2016). Our results showed that patients on RRT engaged in low levels of physical activity.…”

“…Hemodialysis (HD) is the most common renal replacement, but other possibilities include peritoneal dialysis (PD). Thus, it is increasingly common to find elderly patients with a high level of comorbidity characterized by fragility and a high risk of functional impairment (Portilla Franco et al, 2016). Age, malnutrition, anemia, chronic inflammation, alterations in bone mineral metabolism, as well as high levels of associated comorbidity and alterations in urea metabolism can all contribute to progressive general worsening of health among patients with CKD-5D.…”

“…Age, malnutrition, anemia, chronic inflammation, alterations in bone mineral metabolism, as well as high levels of associated comorbidity and alterations in urea metabolism can all contribute to progressive general worsening of health among patients with CKD-5D. In the shorter-term, this can lead to muscular weakness, and over the longer-term, to individuals becoming dependent upon others to complete their daily life activities (Portilla Franco et al, 2016).…”

Optimizing dialysis dose in the context of frailty: an exploratory study

“…As for the biochemical parameters, the significantly lower serum creatinine in older patients can be attributed to the characteristic sarcopenia of this group, since the magnitude of muscle mass directly impacts on serum creatinine levels [18].…”

Beneficios del ejercicio físico en la sesión de hemodiálisis. Una revisión sistemática

“…La ERCA presenta en la actualidad una incidencia y prevalencia crecientes, afectando a un porcentaje significativo de la población mundial, debido fundamentalmente, a que sus causas principales residen en trastornos de alta prevalencia como el envejecimiento, la hipertensión arterial, la diabetes y la enfermedad vascular 2,3 . Además del descenso del filtrado glomerular, la ERCA provoca un estado inflamatorio que condiciona cambios fisiológicos con repercusión a nivel de otros órganos 4 . Esta evolución irreversible de la ERCA condiciona el estadio final de la misma que conduce inexorablemen-te a la necesidad de una TRS.…”