Abstract
Objectives
To perform a comprehensive evidence synthesis to summarize the impact of frailty on
health outcomes in patients with chronic kidney disease (CKD).
Design
Systematic reviews and meta-analysis.
Setting
Electronic searches in PubMed, Embase, Web of Science, CNKI, VIP, CBM, and Wanfang
Database were performed. The methodological quality was evaluated using the Newcastle
Ottawa Scale (NOS).
Participants
Patients with chronic kidney disease (CKD).
Measurements
Potential clinical outcomes due to frailty.
Results
Eighteen cohort studies incorporating a total of 22,788 participants were included.
The overall risk of bias was low. The median reported prevalence of frail and prefrail
individuals with CKD was 41.8% (range 2.8-81.5%) and 43.9% (range 19.1-62.7%), respectively.
Prefrailty and frailty related to mortality indicated an increased hazard ratio (HR),
with a pooled HR of 1.68 [95% confidence interval (CI) 1.46-1.94; P < .001] and 1.48 (95% CI 1.21-1.81; P < .001), respectively. Prefrailty and frailty related to hospitalization with the
pooled HR/risk ratio (RR) of 1.56 (95% CI 1.37-1.76; P < .001) and 1.21 (95% CI 0.79-1.85; P = .38), respectively. Similarly, the pooled HR demonstrated a strong correlation
between frailty and falls in patients with CKD with HR 1.83 (95% CI 1.40-2.37; P < .001) and no statistical correlation between prefrailty and falls in these patients
with pooled HR 1.19 (95% CI 0.44-3.22; P = .73), respectively.
Conclusions and Implications
Frailty is predictive of negative outcomes in patients with CKD, including all-cause
mortality, all-cause hospitalization, and falls. Therefore, frailty should be routinely
assessed among patients with CKD to prevent poor prognosis, reduce fatality rate,
and provide evidence to support future targeted interventions. However, because of
the limited amount of information currently in the literature, additional prospective
studies are needed to explore the role of prefrailty in predicting adverse outcomes
for patients with CKD.
Keywords
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Article info
Publication history
Published online: November 18, 2020
Footnotes
F.M. and Q.G. are co–first authors.
This work was supported by the Natural Science Foundation of China (Number: 81873184).
The authors declare no conflicts of interest.
Identification
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
