Frailty and mortality among patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis

Zhang, Quanchao; Ma, Yingying; Lin, Faying; Zhao, Jinghong; Xiong, Jiachuan

doi:10.1007/s11255-019-02369-x

Cited by 47 publications

(41 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings demonstrate that frailty increases the risk of all-cause mortality in ESRD patients undergoing hemodialysis, which is similar to previous reviews [18,36]. Frailty is a multidimensional syndrome that leads to decline in activity and inadequate response to health stressors due to sarcopenia, vulnerability, and impaired endurance [18].…”

Section: Discussionsupporting

confidence: 89%

“…Frailty is characterized by reduced cognitive and physiologic reserves which lead to greater vulnerability [17]. Frailty is prevalent in patients with all stages of CKD and two-thirds of patients with ESRD [18,19]. ESRD patients with frailty are vulnerable to adverse outcomes including an increased risk of disability, hospitalization, and mortality [19].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

Lee

Son

2021

IJERPH

View full text Add to dashboard Cite

Hemodialysis is the most common type of treatment for end-stage renal disease (ESRD). Frailty is associated with poor outcomes such as higher mortality. ESRD patients have a higher prevalence of frailty. This systematic review and meta-analysis aimed to identify the prevalence and associated factors of frailty and examine whether it is a predictor of mortality among ESRD patients undergoing hemodialysis. Five electronic databases including PubMed, Embase, CINAHL, Web of Science, and Cochrane Library were searched for relevant studies up to 30 November 2020. A total of 752 articles were found, and seven studies with 2604 participants in total were included in the final analysis. The pooled prevalence of frailty in patients with ESRD undergoing hemodialysis was 46% (95% Confidence interval (CI) 34.2−58.3%). Advanced age, female sex, and the presence of diabetes mellitus increased the risk of frailty in ESRD patients undergoing hemodialysis. Our main finding showed that patients with frailty had a greater risk of all-cause mortality compared with those without (hazard ratio (HR): 2.02, 95% CI: 1.65−2.48). To improve ESRD patient outcomes, healthcare professionals need to assess the frailty of older ESRD patients, particularly by considering gender and comorbidities. Comprehensive frailty screening tools for ESRD patients on hemodialysis need to be developed.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

Lee

Son

2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…The prevalence of frailty among patients with nondialysis CKD ranged from 7.9% [ 9 ] to 16% [ 10 ], whereas that of frailty among patients with severe CKD was 20.9% [ 9 ]. The presence of frailty among patients with CKD has also been associated with a 1.95-fold increase in the risk of all-cause mortality [ 11 ]. In addition, frailty decreases quality of life in patients with CKD [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study

et al. 2020

View full text Add to dashboard Cite

Background: Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods: This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3-5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results: In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47-0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion: We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.

show abstract

“…Importantly, frailty and its precursor pre-frailty are associated with adverse health outcomes [4]. Within CKD populations, frailty is associated with worse health-related quality (HRQOL) [5], falls [6], hospitalisation [7] and mortality [8]. Validated frailty screening and assessment tools are available [9] and are increasingly used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial

et al. 2021

View full text Add to dashboard Cite

Background Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). Evidence supporting targeted interventions is needed. This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. Methods Participants were recruited from nephrology outpatient clinics to this two-arm parallel group mixed-methods pilot RCT. Inclusion criteria were: ≥65 years old; CKD G3b-5; and Clinical Frailty Scale score ≥4. Participants categorised as pre-frail or frail using the Frailty Phenotype were randomised to a 12-week progressive multi-component home-based exercise programme or usual care. Primary outcome measures included eligibility, recruitment, adherence, outcome measure completion and participant attrition rate. Semi-structured interviews were conducted with participants to explore trial and intervention acceptability. Results Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% CI 29, 36) eligible. Thirty-five (16%; 95% CI 12, 22) participants were recruited. Six were categorised as robust and withdrawn prior to randomisation. Fifteen participants were randomised to exercise and 14 to usual care. Eleven (73%; 95% CI 45, 91) participants completed ≥2 exercise sessions/week. Retained participants completed all outcome measures (n = 21; 100%; 95% CI 81, 100). Eight (28%; 95% CI 13, 47) participants were withdrawn. Fifteen participated in interviews. Decision to participate/withdraw was influenced by perceived risk of exercise worsening symptoms. Participant perceived benefits included improved fitness, balance, strength, well-being, energy levels and confidence. Conclusions This pilot RCT demonstrates that progression to definitive RCT is possible provided recruitment and retention challenges are addressed. It has also provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and CKD. Trial registration ISRCTN87708989; https://clinicaltrials.gov/.

show abstract

Frailty and mortality among patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis

Cited by 47 publications

References 34 publications

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study

Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial

Contact Info

Product

Resources

About