Assessment and risk factors for protein-energy wasting and frailty in chronic kidney disease

Abstract With higher morbidity and mortality in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) populations compared to the general population, factors contributing to these poor outcomes may not simply be explained by metabolic derangements in CKD. Chronic inflammatory and catabolic states are commonly seen in this patient population can contribute to malnutrition and poor functional status. Consequently, protein-energy wasting (PEW) and frailty, both well-recognized geriatric syndromes, are common in the CKD population. However, given the complex pathogenesis of these conditions as well as logistical aspects to early identification and diagnosis of PEW and frailty, the opportunity to intervene in these conditions may be delayed or even missed. Multiple operational tools exist to define frailty and PEW in both clinical practice and research settings, all of which have been shown to correlate with clinical outcomes. These different tools have their own advantages and limitations that should be taken into consideration when they are applied in different clinical settings. This chapter provides an overview of the definitions and an assessment of the diagnostic tools used for screening and diagnosing PEW and frailty in the CKD and ESKD population. The risk factors of PEW and frailty are also reviewed.