Background: The mean age of people undergoing dialysis therapy has been on the rise because of improved survival in this patient population, as well as the reduced availability of transplants for elderly patients. Aging in Japanese dialysis patients is more rapid than those in the United States and Europe. Frailty is generally considered as an age-related fragile state, and a condition in which the individual is in a vulnerable state at increased risk of adverse health outcomes and/or dying when exposed to a stressor. This review focuses on the underscoring the importance of identifying physical frailty in hemodialysis patients and proposes an algorithm integrating frailty assessment into the routine care of patients treated with dialysis. Summary: Physical frailty is highly prevalent in patients undergoing hemodialysis, and can potentially be prevented or treated with management of physical frailty. The management of physical frailty consists of identifying physical inactivity and poor physical performance and the individualized prescription of exercise. While expert clinical guidelines focus on management of patients in the outpatient dialysis care setting, it is not included in routine clinical care of dialysis facilities. Little is known about the management of frailty in the hemodialysis population and its effects on health outcomes. Further research is needed to define optimal strategies for screening and treatment of frailty in this vulnerable population.
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