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

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.