Abstract
BackgroundFrailty is a condition characterized by a decline in physical function and functional capacity. Common symptoms of frailty, such as weakness and exhaustion, are prevalent in patients with chronic kidney disease (CKD). The increased vulnerability of frail patients with coexisting CKD may place them at a heightened risk of encountering additional health complications. The purpose of this systematic review was to explore the link between frailty, CKD and clinical outcomes.MethodsWe searched for cross sectional and prospective studies in the general population and in the CKD population indexed in EMBASE, Pubmed, Web of Science, CINAHL, Cochrane and Ageline examining the association between frailty and CKD and those relating frailty in patients with CKD to clinical outcomes.ResultsWe screened 5,066 abstracts and retrieved 108 studies for full text review. We identified 7 studies associating frailty or physical function to CKD. From the 7 studies, we identified only two studies that related frailty in patients with CKD to a clinical outcome. CKD was consistently associated with increasing frailty or reduced physical function [odds ratios (OR) 1.30 to 3.12]. In patients with CKD, frailty was associated with a greater than two-fold higher risk of dialysis and/or death [OR from 2.0 to 5.88].ConclusionsCKD is associated with a higher risk of frailty or diminished physical function. Furthermore, the presence of frailty in patients with CKD may lead to a higher risk of mortality. Further research must be conducted to understand the mechanisms of frailty in CKD and to confirm its association with clinical outcomes.
Highlights
Frailty is a condition characterized by a decline in physical function and functional capacity
Search strategy and selection criteria We aimed to identify observational studies of humans that explored the link between frailty, chronic kidney disease (CKD), and clinical outcomes
The following electronic databases were searched from their date of establishment to March 2013: EMBASE, PubMed, Web of Science (WOS), CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), and AgeLine
Summary
Frailty is a condition characterized by a decline in physical function and functional capacity. Common symptoms of frailty, such as weakness and exhaustion, are prevalent in patients with chronic kidney disease (CKD). The overall prevalence of CKD is roughly 10% in the general population, the disease increases with age, affecting more than one third of all individuals over age 65 [2] In this population, CKD is associated with additional comorbid conditions; a higher risk of cardiovascular disease and increasing prevalence of frailty and disability [3,4]. Many of the physiological changes resulting from CKD are altered mineral metabolism, chronic inflammation and arteriosclerosis These physiological changes directly or indirectly influence sarcopenia and weakness, which are core domains of the frailty construct [10]. Given that frailty may be modifiable using readily available interventions, the study of frailty in the patient with CKD seems important [11]
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