Frailty in the elderly or any patient leading towards ESRD is a tough combination. Renal physicians should not consider dialysis as the de facto treatment for all patients and in certain patients that meet some frailty criteria, perhaps non dialysis modalities with multi team approach and renal palliative care might be better options. Recent article in CJASN explores the Frail Renal Phenotype
1. Karnofsky score <50( requires special care)
2. Older age compared 80-84 : 85-89 years
3. Presence of geriatric factors and syndromes: Dementia, non ambulatory status, positive frailty test, low serum albumin, symptom burden that is high.
4. " Would you be surprised if this patient died in the next year?" answer being No
5. Low survival probability by comorbid scores, hemodialysis mortality index, and nursing four chronic conditions and nursing home patient.
Take a look at the full article at CJASN 2013
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