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Part II Nutrition Assessment, Consequences, and Implications
Figure 12.1 Clinical Consequences of Frailty and Protein-Energy Wasting in Elderly Patients With Stage 5 Chronic Kidney Disease on Dialysis
Impaired cognitive function, reduced emotional resources, depression
Impaired socialization
Decreased vocational activity, decreased income
Frequent superimposed illnesses, more serious illnesses
e
Peripheral vascular disease, Ischemic ulcers, gangrene
t m o PEW Combined Frailty & PEW
Bone loss, increased falls/fractures
Frailty a b Earlier death
Poorer quality of life Malaise, lack of vigor, Sleep disorders, Constrictive life style, Decreased sexual function, Fecal incontinence
Source: Reprinted with permission from Kim JC, Kalantar-Zadeh K, Kopel J. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol. 2013;24:337-351.
Impaired physical functioning ↓ Exercise endurance, ↓ Strength, ↓ Balance & coordination, ↓ Speed of movement
Increased cardiovascular risk Hypertension, Dyslipidemia, Ischemic heart disease, Heart failure
TABLE 12.1 Chronic Kidney Disease: A Clinical Action Plan Stage Description
GFR (mL/min/1.73 m2 At increased risk 1 2
3 4 5
a
Kidney damage with normal or ↑ GFR
Kidney damage with mild ↓ GFR
Moderate ↓ GFR Severe ↓ GFR Kidney failure
Includes actions from preceding stages.
Shaded area identifies patients who have CKD; unshaded area designates individuals who are at increased risk for developing CKD. Chronic kidney disease is defined as either kidney damage or GFR less than 60 mL/min/1.73 m2
for more than three months. Kidney damage is de-
fined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies. Abbreviations: GFR, glomerular filtration rate; CKD, chronic kidney disease; CVD, cardiovascular disease.
≥ 60 (with CKD risk factors) ≥ 90
60–89
30–59 15–29
< 15 (or dialysis)
Actiona Screening, CKD risk reduction
Diagnosis and treatment, treatment of comorbid conditions, slowing progression, CVD risk reduction
Estimating progression
Estimating and treating complications Preparation for kidney replacement therapy Replacement (if uremia present)
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