Geriatric approaches to rehabilitation strategies in elderly and very old patients with chronic kidney disease

The number of patients with chronic kidney disease (CKD) is rising rapidly worldwide, making it a major public health concern. CKD is associated with geriatric syndromes such as frailty, sarcopenia, malnourishment, reduced mobility and falls, cognitive impairment and depression. Despite their prevalence, these syndromes often remain undiagnosed, leading to functional dependence, reduced quality of life, increased hospitalizations and higher risk of mortality.

Progression of CKD results in functional limitations and severe disability, significantly diminishing quality of life, and underscoring the need for rehabilitation strategies – particularly in elderly patients with multiple comorbidities. Assessing functional status is especially important because initiating renal replacement therapy in the end-stage CKD may further functional capacity or even reduce survival in frail elderly adults.

Functional status in elderly and very old patients refers to the ability to independently perform daily activities, use household appliances, maintain personal hygiene and a safe living environment, and manage personal finances. Rehabilitation programs for patients with CKD and acute renal injury (AKI) should include physical activity and nutritional support, which may improve functional independence and daily activity in older adults. Elderly patients recovering from AKI often experience a decline in the quality of life and progression of frailty; in such, rehabilitation is essential for maintaining functional status, although it is more challenging.

Rehabilitation should be tailored to the individual needs of patients with CKD within a holistic framework that accounts for the degree of renal impairment, complications, and comorbidities. An interdisciplinary care team can be more effective than a conventional, disease-focused approach. This article presents recommendations for interventions aimed at preserving age-related frailty and other geriatric syndromes, such as falls and sarcopenia, in elderly and very old patients with chronic kidney disease.

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