Servicio de Nefrología, Hospital del Mar, Barcelona, España.
Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, España.
Nefrologia (Engl Ed). 2021 May-Jun;41(3):237-243. doi: 10.1016/j.nefro.2020.09.004. Epub 2020 Dec 16.
Frailty is a concept that has been mainly developed in geriatrics and it came from the need of identifying subjects at risk to develop complications when they faced a stressful event. Frail patients have higher risk of mortality, poor outcomes and disability, and this is independent from their age or comorbidities. Chronic kidney disease patients present with high prevalence of frailty, especially those who are in renal replacement therapy. Frail or pre-frail patients on the kidney transplant waiting list represent 20-30%, and these patients are proven to have poorer results after the transplant, which is a stressful event itself. Tools for frailty assessment, both scales or indexes, may be useful to identify which subjects might be at risk for complications after transplant, and this is necessary to adapt our clinical practice and minimize morbidity. The most used frailty scale in kidney patients is Fried scale, which is based in five phenotypic items. Besides that, knowing frail population allows potential interventions such as prehabilitation while the patient is waiting for the kidney transplant, which the aim of improving their vulnerability prior to transplant and, therefore, optimizing results after transplant. More studies are needed amongst kidney patients to improve and prevent frailty.
虚弱是一个主要在老年医学中发展起来的概念，它源于识别面临压力事件时易发生并发症的患者的需求。虚弱患者的死亡率、不良结局和残疾风险更高，这与他们的年龄或合并症无关。慢性肾脏病患者的虚弱发生率较高，尤其是那些正在接受肾脏替代治疗的患者。在等待肾移植的患者中，虚弱或易变虚弱的患者占 20-30%，这些患者在移植后证明结果较差，这本身就是一个压力事件。虚弱评估工具，无论是量表还是指数，都可能有助于识别哪些患者在移植后可能面临并发症风险，这对于调整我们的临床实践和降低发病率是必要的。在肾脏病患者中使用最广泛的虚弱量表是基于五个表型项目的 Fried 量表。除此之外，了解虚弱人群还可以进行潜在的干预，如预康复，当患者等待肾移植时，目的是改善他们在移植前的脆弱性，从而优化移植后的结果。需要在肾脏病患者中开展更多的研究来改善和预防虚弱。
