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Related Concept Videos

Dialysis01:27

Dialysis

Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Dialysis01:15

Dialysis

Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
Hemodialysis III: Nursing Management01:25

Hemodialysis III: Nursing Management

The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this measurement...
Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...

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Updated: May 8, 2026

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
05:53

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

Published on: July 24, 2013

Frailty and dialysis initiation.

Kirsten L Johansen1, Cynthia Delgado, Yeran Bao

  • 1Division of Nephrology, Department of Medicine, University of California, San Francisco, California; Nephrology Section, VA Medical Center, San Francisco, California.

Seminars in Dialysis
|September 6, 2013
PubMed
Summary
This summary is machine-generated.

Frailty is more common in chronic kidney disease (CKD) patients and linked to worse outcomes. Early dialysis initiation does not appear to benefit frail patients, with no improvements in survival or function observed.

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Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
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Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis
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Published on: July 19, 2018

Area of Science:

  • Gerontology and Nephrology
  • Physiology and Clinical Medicine

Background:

  • Frailty, a state of increased vulnerability due to diminished physiological reserves, is characterized by poor physical function, exhaustion, low activity, and weight loss.
  • Frailty is more prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) compared to the general population.
  • Frailty is associated with adverse outcomes in patients initiating dialysis, including increased hospitalization and mortality risks.

Purpose of the Study:

  • To investigate the relationship between frailty and CKD, and its impact on outcomes in patients undergoing dialysis.
  • To determine if frailty in CKD patients is a consequence of uremia or independent of the disease.
  • To evaluate the effect of early dialysis initiation on frailty and functional status in CKD patients.

Main Methods:

  • Review and synthesis of existing studies examining frailty prevalence in CKD/ESRD populations.
  • Analysis of data on the association between frailty and adverse outcomes in incident dialysis patients.
  • Examination of evidence regarding the trajectory of frailty before and after dialysis initiation, including estimated glomerular filtration rate (eGFR) at initiation.

Main Results:

  • Frailty is significantly more common in individuals with CKD.
  • Frail patients initiating dialysis face higher risks of hospitalization and death.
  • Frail patients are initiated on dialysis earlier (higher eGFR), but data do not indicate improved survival or functional status (ADLs) post-initiation; frailty may worsen.

Conclusions:

  • Frailty is a significant concern in CKD patients, associated with poor prognosis.
  • The benefits of early dialysis initiation for frail CKD patients remain unproven, with no observed improvements in survival or functional status.
  • Frailty may confound observational studies suggesting survival benefits from early dialysis initiation.