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Table of Contents
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 13


1 PhD Scholar, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
2 Post-Doctoral Fellow, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
3 Associate Professor, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA

Date of Web Publication16-May-2018

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-1540.232543

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How to cite this article:
Tallman D, Kaur D, Khosla P. Frailty. J Renal Nutr Metab 2018;3:13

How to cite this URL:
Tallman D, Kaur D, Khosla P. Frailty. J Renal Nutr Metab [serial online] 2018 [cited 2020 Aug 11];3:13. Available from: http://www.jrnm.in/text.asp?2018/3/1/13/232543

  Definition of Frailty Top

Frailty is a condition of increased vulnerability to physical stressors as a result of accumulation of multiple deficits across various systems. It is characterized by diminished strength, endurance, and reducedphysiologic function.[1]

  Causes of Frailty Top

There are numerous contributing factorsto the development of frailty including chronic disease, physiological perturbations, and psychosocial impairment. Sarcopenia, aprogressive decline in muscle mass as a result of the aging process, and dynapenia, loss of strength with aging, are believed to be precursors to frailty.[2] In the chronic kidney disease (CKD) population, frailty is associated with sarcopenia, dynapenia, protein energy wasting (loss of somatic and circulating protein and energy reserves) and other CKD complications.[3] Prevalence of this syndrome is much higher in CKD than in the general population and increases with decliningrenal function.[4]

  Clinical Implications of Frailty in CKD Top

Frailty is associated with impaired physical performance, disability, reduced quality of life, and increased hospitalization and mortality rates. Diminished intakes of dietary protein and energy contribute to sarcopenia and protein energy wasting, further leading to frailty.

  Identification of Frailty Top

Although no consensus on the operational definition and methods for identification havebeen established, several tools to assess frailty are available. The Fried Phenotype Model defines those with frailty as meeting three out of five criteria: (1) low grip strength, (2) self-reported exhaustion, (3) slowed walking speed,(4) low physical activity, (5) and unintentional weight loss.[5] A Frailty Index score, calculated by totaling the number of deficits from a broad range of medical and psychological conditions, is another predictive model; however, it is time-consuming to conduct. Clinical Frailty Scales (CFS), which rely solely on judgement, are more widely used in the clinical setting as screening tools.[6],[7] Although not an exhaustive list, these screening tools can be used by cliniciansto identify high risk patients.

  Prevention of Frailty Top

Currently there are no established interventions for the prevention and treatment of frailty. An interdisciplinary approach which includes nutritional, cognitive, and physical intervention may attenuate the morbidity associated with frailty. Nutritional interventions include identificationof possible causes for reduced appetite, initiation of oral supplementation, correction of metabolic acidosis, optimal fluid management, incorporation of resistance exercise, and promotion of adequate vitamin D status.

  References Top

Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392-7.  Back to cited text no. 1
Wilson D, Jackson T, Sapey E, et al. Frailty and sarcopenia: The potential role of an aged immune system. Ageing Res Rev 2017;36:1-10.  Back to cited text no. 2
Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol 2013;24:337-51.  Back to cited text no. 3
Kojima G. Prevalence of frailty in end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 2017;49:1989-97.  Back to cited text no. 4
Fried LP, Tangen CM, Walston J. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:146-56.  Back to cited text no. 5
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.  Back to cited text no. 6
Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb 2012;42:333-40.  Back to cited text no. 7


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Definition of Fr...
Causes of Frailty
Clinical Implica...
Identification o...
Prevention of Fr...

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