Table 3.

Impact of Frailty on Management of Patients With End-Stage Kidney Disease.

Frailty aspects	Clinical considerations	Health care challenges
Cognitive impairment	Degree of impairment and appropriateness of dialysis Progression can be more rapid after starting dialysis Impacts on ability to cope with rigors of dialysis	Incorporation of cognitive assessment into routine nephrological care Time for complex discussions and advance care planning Adjustment to dialysis
Functional impairment	Potential impact of dialysis on functional decline Dependence and optimal dialysis modality Exercise as a preventive strategy Falls and fracture risk Transport requirements	Liaison with geriatric teams for assessment, falls clinics, and community support Involvement of rehabilitation teams Routine use of exercise physiotherapists Cost of transport
Protein energy wasting	Associated with poor prognosis Ensuring adequate nutritional support	Regular dietetic review and access to nutritional supplements Support in community for shopping, preparing food
Multimorbidity	Polypharmacy and risk of adverse reactions Associated with poor prognosis Multiple clinic visits Increased risk of hospitalization	Involvement of pharmacists to review medications Need to focus goals of care