Prehabilitation in end stage kidney disease

Abstract

Clinical frailty and sarcopaenia are significant consequences of end stage kidney disease (ESKD), affecting up to 75% of dialysis patients (Bao et al, 2012). Their development is a multifactorial and complex sequence of events, largely driven by disease and dialysis-related inflammation and catabolism and uraemia (Kim et al, 2013), and significantly impacts several outcomes, including reduced quality of life (Mansur et al, 2014), increased rate of disease progression (Roshanravan et al, 2012), increased hospitalisation (Kang et al, 2017) and significantly increased mortality risk (McAdams-DeMarco et al, 2013). Many studies that aim to mitigate against frailty, sarcopaenia and related complications of ESKD comprise single interventions, however, the role of multi-component interventions in preventing functional and nutritional decline, maintaining quality of life, and improving survival in patients with ESKD is an emerging area of interest. This paper outlines the potential role for these multi-component interventions and the role of prehabilitation in ESKD.