Frailty in patients with pre-dialysis chronic kidney disease: Toward successful aging of the elderly patients transitioning to dialysis in Japan

Abstract

Japan has been recognized as having best prognosis of dialysis patients in the world; however, the early mortality of elderly incident dialysis patients is the same as or even worse compared to that in the developed countries in the Western world. One leading reason of this is rapidly growing number of frail aging population among incident dialysis patients. Frailty in elderly incident dialysis patients was prevalent and severe in degree, and frailty develops in the continuous process. We investigated in pre-dialysis patients of ours to find that physical functional decline is prevalent and develops in early stages in chronic kidney disease (CKD), and mild cognitive impairment is also prevalent in CKD and is associated with physical functioning decline. We demonstrated that even the home-based exercise may improve physical activity and function in elderly CKD patients. We also pay attention to our routine medical practice if it really helps our patients achieve successful aging. Although recommended in the clinical practice guidelines, protein restriction and intensive blood pressure control, especially in frail elderly with CKD, may not be so effective as in younger counterparts and even be harmful to them. We also need to check how patients face with their reality with illness and how much hope they have. We just need to pause, look back, and reconsider what we usually do and try our best to think what we can do our best to achieve the successful aging of our elderly patients with CKD.