Frailty And Kidney Disease

This unique book reviews the information available in the literature regarding the new syndrome, frailty, in patients with various renal conditions, such as acute kidney injury, chronic kidney disease, as well as dialysis and transplant patients. The topic is of importance in nephrology, specifically nephrogeriatrics, since frailty is a condition affecting many elderly patients and which is becoming increasingly common in medical practice. As such, there is a considerable need for information to assist professionals treating these patients. The book includes chapters on the frailty syndrome (definition, evaluation and treatment), the main geriatric syndromes (gait disorder, falls, incontinence, and delirium), the main renal syndromes (acute renal injury, chronic kidney disease) as well as dialysis and kidney transplant, and the relationship between geriatrics and renal syndromes. Frailty and Kidney Disease: A Practical Guide to Clinical Management is an essential resource for general practitioners, researchers, internal medicine physicians, geriatricians, and nephrologists.

This book highlights recent advances in our understanding of sarcopenia and frailty in CKD. The prevalence of sarcopenia and frailty increases substantially as CKD progresses, and experimental studies have demonstrated the pivotal role of accumulated uremic toxin in the development of muscle wasting. Further, sarcopenia and frailty are associated with falls, bone fractures, cognitive impairment, and poor survival prognoses, especially in elderly CKD patients. The syndromes are also related to the risk of end-stage kidney disease. This book provides readers with a deeper understanding of the prevention and management of sarcopenia and frailty in CKD patients to improve their renal and overall health, and suggests directions for future basic and clinical research.

This book offers an up-to-date review on the principles and practice of multidimensional assessment and management of the older individual, which represents the cornerstone of modern clinical practice in the elderly. The early chapters cover the main elements and scope of the comprehensive geriatric approach and explain the pathways of care from screening and case finding through to in-depth assessment and treatment planning. Subsequent chapters review the evidence of how best to apply the multidimensional assessment and management approach in defined healthcare settings and within specific clinical areas, such as cancer and surgery. Finally, the education and training challenges are reviewed and the prospects for future clinical service and research in this important field are examined. The book is very timely given the recent advances in application of this approach, which reflect the growing international realization that older people are “core business” in many clinical areas where the role of specialist geriatric medicine has hitherto been limited. Accordingly, the book will be relevant to a wide range of clinicians. The authorship comprises many of the best known and widely published experts in their respective fields.

This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.

This translational text offers in-depth reviews of the metabolic and nutritional disorders that are prevalent in patients with renal disease. Chapter topics address the growing epidemic of obesity and metabolic syndrome. Each chapter integrates basic and clinical approaches, from cell biology and genetics to diagnosis, patient management and treatment. Chapters in sections 4-7 include new illustrative case reports, and all chapters emphasize key concepts with chapter-ending summaries. New features also include the latest National Kidney Foundation Clinical Practice Guidelines on Nutrition in Chronic Renal Failure, the most recent scientific discoveries and the latest techniques for assessing nutritional status in renal disease, and literature reviews on patients who receive continuous veno-venous hemofiltration with or without dialysis. Provides a common language for nephrologists, nutritionists, endocrinologists, and other interested physicians to discuss the underlying research and translation of best practices for the nutritional management and prevention of renal disease Saves clinicians and researchers time in quickly accessing the very latest details on nutritional practice as opposed to searching through thousands of journal articles Correct diagnosis (and therefore correct treatment) of renal, metabolic, and nutritional disorders depends on a strong understanding of the molecular basis for the disease - both nephrologists and nutritionists will benefit Nephrologists and nutritionists will gain insight into which treatments, medications, and diets to use based on the history, progression, and genetic make-up of a patient Case Reports will offer an added resource for fellows, nutritionists, and dieticians who need a refresher course

This publication is a record of some of the outstanding presentations given at the 63rd Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT). The meeting was held in Kobe in 2018, celebrating the 50-year anniversary of the founding of the JSDT as a voluntary academic association. Therapy for end-stage kidney disease (ESKD) now faces vital issues besides the management of renal anemia and chronic kidney disease-mineral and bone disorder and the selection of the optimal treatment modality for each patient. These issues include the increasing incidence of malnutrition and frailty in the elderly, fragile vascular access, and the balance between medical costs and budgets. Expert members of the JSDT present 15 articles that address these issues. This book serves to promote further progress in understanding the pathogenesis of complications associated with ESKD and providing optimal therapy for patients.

Malnutrition is becoming a more prominent health problem, with an increasing number of elderly CKD patients being put on dialysis. In addition, the presence of inflammation, sarcopenia/frailty, diabetes, and CVD is a definite and independent risk factor associated with higher mortality in this population. Although the restriction of protein intake has been recommended to protect eGFR decline, hyperphosphatemia, and hyperkalemia in CKD patients, it might accelerate the loss of skeletal muscle and adipose mass, leading to a poor prognosis. Therefore, flexible responses are considered regarding whether protein restriction should be continued or loosened in pre-dialysis CKD patients. In undernourished elderly patients undergoing hemodialysis, sufficient calorie/protein intake is necessary to counteract the development of sarcopenia/frailty. It is expected that the application of new drugs including phosphate binders and potassium chelators may achieve both a high enough intake and balanced levels of phosphate and potassium. Furthermore, the improvement of deficient micronutrients and poor appetite is also necessary. Comprehensive care is essential for the wellbeing of elderly patients undergoing hemodialysis. The topicof this Special Issue is "Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life".

Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the core palliative knowledge and skills needed to deliver high value, high quality care for seriously ill patients with chronic and end-stage kidney disease. Chapters are written by a team of international leaders in kidney palliative care and are organized into sections exploring unmet supportive care needs, palliative care capacity, patient-centered care, enhanced support at the end of life, and more. Chapter topics are based on the Coalition for Supportive Care of Kidney Patients Pathways Project change package of 14 evidence-based best practices to improve the delivery of palliative care to patients with kidney disease. An overview of the future of palliative care nephrology with attention to needed policy changes rounds out the text. Palliative Care in Nephrology is an ideal resource for nephrologists, nurses, nurse practitioners, physician assistants, social workers, primary care clinicians, and other practitioners who wish to learn more about integrating individualized, patient-centered palliative care into treatment of their patients with kidney disease.