Frailty and Dialysis Initiation
Frailty and Dialysis Initiation
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DOI：
10.1111/sdi.12126
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发表时间：
2013-11-01
影响因子：
1.6
通讯作者：
Tamura, Manjula Kurella
中科院分区：
文献类型：
--
作者：
Johansen, Kirsten L.;Delgado, Cynthia;Tamura, Manjula Kurella
虚弱是由于生理储备减少或多个生理系统失调而导致的对压力源的脆弱性增加的一种生理状态。虚弱的概念被解释为身体机能差、疲惫、体力活动少和体重减轻的综合表现。目前有几项研究调查了慢性肾病 (CKD) 或终末期肾病 (ESRD) 患者虚弱的患病率，发现患有 CKD 的人比没有 CKD 的人更容易虚弱。此外，虚弱与透析患者的不良后果相关，包括较高的住院和死亡风险。最近的证据表明，体弱患者平均比体弱患者更早开始透析（估计肾小球滤过率 [eGFR] 较高），但尚不清楚这些患者的体弱是否是尿毒症的结果，还是独立于 CKD。观察性研究中与早期开始透析相关的生存劣势可能部分是通过基于无法测量的虚弱的混杂因素来调节的。然而，现有数据并未表明开始透析后虚弱状况得到改善；相反，透析开始后的轨迹似乎是对日常生活活动（ADL）的依赖程度更高。总体而言，没有数据表明体弱的患者可以从早期开始透析中获得任何益处，无论是改善生存还是功能状态。
Frailty is a physiologic state of increased vulnerability to stressors that results from decreased physiologic reserves or dysregulation of multiple physiologic systems. The construct of frailty has been operationalized as a composite of poor physical function, exhaustion, low physical activity, and weight loss. Several studies have now examined the prevalence of frailty among chronic kidney disease (CKD) or end-stage renal disease (ESRD) patients and have found frailty to be more common among individuals with CKD than among those without. Furthermore, frailty is associated with adverse outcomes among incident dialysis patients, including higher risk of hospitalization and death. Recent evidence shows that frail patients are started on dialysis earlier (at a higher estimated glomerular filtration rate [eGFR]) on average than nonfrail patients, but it remains unclear whether these patients' frailty is a result of uremia or is independent of CKD. The survival disadvantage that has been associated with early initiation of dialysis in observational studies could be mediated in part through confounding on the basis of unmeasured frailty. However, available data do not suggest improvement in frailty upon initiation of dialysis; rather, the trajectory appears to be toward higher levels of dependence in activities of daily living (ADLs) after dialysis initiation. Overall, there are no data to suggest that frail patients derive any benefit from early initiation of dialysis either in the form of improved survival or functional status.