Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
Division of Nephrology and Hypertension, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA.
Kidney Int. 2024 Jul;106(1):35-49. doi: 10.1016/j.kint.2024.02.026. Epub 2024 May 3.
Frailty is a condition that is frequently observed among patients undergoing dialysis. Frailty is characterized by a decline in both physiological state and cognitive state, leading to a combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, and slow walking speed. Frail patients not only experience a poor quality of life, but also are at higher risk of hospitalization, infection, cardiovascular events, dialysis-associated complications, and death. Frailty occurs as a result of a combination and interaction of various medical issues in patients who are on dialysis. Unfortunately, frailty has no cure. To address frailty, a multifaceted approach is necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, and family members. Strategies such as optimizing nutrition and chronic kidney disease-related complications, reducing polypharmacy by deprescription, personalizing dialysis prescription, and considering home-based or assisted dialysis may help slow the decline of physical function over time in subjects with frailty. This review discusses the underlying causes of frailty in patients on dialysis and examines the methods and difficulties involved in managing frailty among this group.
虚弱是透析患者中经常观察到的一种情况。虚弱的特征是生理和认知状态的下降，导致一系列症状的出现，如体重减轻、疲惫、低身体活动水平、虚弱和缓慢的步行速度。虚弱的患者不仅生活质量较差，而且住院、感染、心血管事件、透析相关并发症和死亡的风险更高。虚弱是由于透析患者的各种医疗问题的组合和相互作用而发生的。不幸的是，虚弱没有治愈方法。为了解决虚弱问题，需要采取多方面的方法，包括肾病学家、老年病学家、护士、联合健康从业者和家庭成员的协调努力。优化营养和慢性肾脏病相关并发症、通过减药减少多药治疗、个性化透析处方以及考虑家庭或辅助透析等策略可能有助于减缓虚弱患者身体功能的下降。本文讨论了透析患者虚弱的根本原因，并研究了管理该人群虚弱的方法和困难。
