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

  • Nephrology - Original Paper
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Abstract

Purpose

Frailty is highly prevalent among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Previous studies have shown that frailty is a sensitive predictor of survival in the elderly. However, convincing evidence supporting the causality between frailty and the adverse outcome in CKD patients is still lacking.

Methods

PubMed, Embase, MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for identifying potentially relevant literature. Studies that investigated the association between frailty and overall mortality in patients with CKD and ESRD were included. Both unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled for analysis.

Results

Twelve studies involving 127, 373 participants were included for analysis. The results showed that frailty was associated with 2.28-fold increased risk of overall mortality in patients with CKD and dialysis (HR 2.28; 95% CI 1.71–3.05), while 1.95-fold increased after multivariable-adjusted (HR 1.95; 95% CI 1.50–2.53). In addition, subgroup analysis showed that compared with the non-dialysis CKD patients (HR 1.47; 95% CI 1.03–2.11), patients receiving dialysis have higher overall mortality risk (HR 2.19; 95% CI 1.82–2.64). Moreover, frailty can also significantly increase short-term mortality (follow-up < 3 years: HR 2.18, 95% CI 1.76–2.70).

Conclusions

Our results indicated that frailty significantly increased the overall mortality risk in patients with CKD and ESRD, especially in dialysis patients. Frailty can be regarded as a novel independent predictor of mortality for patients with CKD and dialysis.

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Funding

This study was supported by research Grants from the Natural Science Foundation of China (81800616).

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Authors and Affiliations

  1. Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People’s Republic of China

    Quanchao Zhang, Jinghong Zhao & Jiachuan Xiong

  2. Department of Internal Medicine, 953th Hospital, Army Medical University (Third Military Medical University), Shigatse, 857000, People’s Republic of China

    Quanchao Zhang & Faying Lin

  3. Department of Hematology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People’s Republic of China

    Yingying Ma

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  1. Quanchao Zhang
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Correspondence to Jinghong Zhao or Jiachuan Xiong.

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Zhang, Q., Ma, Y., Lin, F. et al. Frailty and mortality among patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 52, 363–370 (2020). https://doi.org/10.1007/s11255-019-02369-x

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  • DOI: https://doi.org/10.1007/s11255-019-02369-x

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