After reassuring the suitability of frail scale in Taiwanese with chronic kidney disease and end stage renal disease, we further evaluated whether frailty exhibited the same degree of outcome association in domestic citizens with renal dysfunction. Whether frailty carry more organ or system directed complications not recognized before in the literature. In those with chronic kidney disease and end stage renal disease, we discovered that frailty increased their risk of having malnutrition with hypoalbuminemia, osteoporosis with vertebral compression fractures. A greater deposition of body fat and developing vascular as that thrombosis compared to [inaudible] counterparts. In addition, for our patients with chronic kidney disease and end stage renal disease, may have subtle central nervous system abnormalities. Presenting as changes in electoral and several graphic signals compared to non frail ones. Our findings, in combination with findings from other research groups with similar interests, prompt to the proposal of a new terminology the frail renal phenotype to describe the presents of frailty in renal patients. In order to stress the prognostic importance of this phenol type in these patients and also to facilitate the spread of this terminology for the use in renal supportive care. Moreover, the persistence of frail renal phenotype in patients with advanced chronic kidney disease, may even increase their risk of entering end-stage renal disease, requiring chronic dialysis. In addition to activating their risk of mortality. What causes frailty in patients with advance chronic kidney disease and end stage renal disease, rendering them vulnerable to a harsh environment? To answer this question, we recently conducted a systematic review in 2019 to address this question. Using original reports involving frail patients with all stages of chronic kidney disease from databases including PubMed, Medline, and Google Scholar between 1980 and 2019. From this systematic review, we retrieved 62 original studies on this issue. Among which 45 percent are from the United States, followed by 11 percent from Taiwan, and 6.5 percent from Canada. Most of these articles from Taiwan, are work stemming from our cohort of geriatric [inaudible] research team which we are proud of. After synthesizing the existing knowledge, we identified that after adjusting for confounders, a multitude of factors contribute to the development of royalty in patients with chronic kidney disease. As is shown in the figure of this line. Social demographic features including advanced age, non-white race, unemployment status, female gender, lower education and lifestyle factors such as smoking, are independently associated with a higher risk of developing frailty. In addition, a great severity of chronic kidney disease most combabilities and depression are also predictors of routing in these random patients. Among all comorbidities, endothelial dysfunction, chronic obstructive, pulmonary disease, obesity and arthritis, are associated with the more than two full increase in the risk of developing frailty. Certain laboratory data are also risk factors for frailty, especially for those under chronic hemodialysis. Hypercarotenemia, hypoalbuminemia, and low testosterone levels brings the effected individuals at risk of developing frailty. In our literature summary, we also identify several features. Might modify the course or the trajectory of frailty in patients with chronic kidney disease. For example, diabetes mellitus and rising inflammatory cytokines, are vowed to predict progressively worsening frailty over years in patients with end-stage renal disease. While higher serum albumin levels predict a course of improving frailty severity. Another study also reported that a longer dialysis duration in patients with end-stage renal disease, correlated with the tendency to have persistent frailty.
