Frailty Among Elderly Patients on Chronic Maintenance Hemodialysis for ESRD: Not Simply a Matter of Chronological Age

Abstract

Frailty is a medical syndrome that is characterized by diminished strength, endurance, and reduced physiologic function, and it increases an individual’s vulnerability for loss of independence and death. There are several measures of frailty in clinical medicine. They include the Fried phenotype scale and the 7-point Clinical Frailty Scale (CFS) developed by The Canadian Society of Health and Aging. Besides, the prevalence of frailty is considerably higher among patients on hemodialysis than among community-dwelling elders. Moreover, overall, there is a general tendency to associate frailty simply with aging. Indeed, de Labra in a recent published study, the VERISAÚDE study, introduced frailty as a multidimensional clinical geriatric syndrome. Despite the foregoing, we had carried out a cross-sectional assessment of ageing and sustainability of maintenance hemodialysis in all four units of the Mayo Clinic Health System outpatient in-center Hemodialysis Program in August 2017 and showed that 69 (50%) were 65 years of age or older. They consisted of 43 males and 26 females; mean age 75.8 ± 7.8 (Standard Deviation (SD)) years, range 65–92 years. They had been on hemodialysis for a mean of 45.8 ± 37.4 months (SD). Age at first hemodialysis treatment for these 69 patients was 71.9 ± 8.4 years (SD), range 53–87 years. Indeed, many of our older patients including octogenarians were doing well with good to excellent quality of life on maintenance hemodialysis. We conclude that frailty and ageing should not be mistaken to be synonymous with each other. We encourage the assessment of frailty scores as an additional clinical tool to help in the decision-making process of if and when to start or continue hemodialysis treatment, whether in the older or younger patients.