Abstract
Patients under dialysis are known to be more vulnerable to frailty, a dynamic geriatric syndrome defined as a state of vulnerability to stressors, due to numerous metabolic changes. With rise of life expectancy globally, it is important to understand the complexity of the pathophysiology of frailty and identify possible markers that can help with the prognosis and diagnosis of frailty. The aim of this systematic review is to give an overview of the knowledge regarding clinical and biochemical markers associated with pre-frailty and frailty in dialysis and pre-dialysis patients. In November 2020, PubMed, Embase and Web of Science were searched. Studies regarding biomarkers associated with (pre-)frailty in (pre-)dialysis patients were included. This systematic review identified clinical and biochemical markers in pre-frail and frail patients under dialysis or pre-dialysis published in the literature. This study shows that more investigation is necessary to identify markers that can differentiate these processes to be used as a diagnostic and prognostic tool in routine care and management of geriatric needs. Interventions that can improve health outcomes in pre-frail and frail older adults under dialysis or pre-dialysis are essential to improve not only the individual’s quality of life but also to reduce the burden to the health systems.
Highlights
IntroductionFrailty is a common clinical complication and a state of physical and biological vulnerability mostly diagnosed in the older population
There are a few systematic reviews published covering biomarkers in frail patients, it is exceedingly rare to find these studies in end-stage renal disease (ESRD) patients
It was observed that sample characteristics were heterogeneous among articles, as Mansur et al and Ali et al reported on pre-dialysis patients and compared frail populations to non-frail; Poveda et al studied ESRD patients under dialysis and compared frail populations to robust and pre-frail; Nakazato et al
Summary
Frailty is a common clinical complication and a state of physical and biological vulnerability mostly diagnosed in the older population. This syndrome is of dynamic nature and is characterized by a progressive decline from robustness to pre-frailty and frailty [1]. The prevalence of frailty and pre-frailty tends to increase with age, and it affects more women compared to men. In a study involving a vast number of participants with a final sample of 60,816 European communitydwelling individuals from 18 different countries aged 50 years old or over, with the mean age of 67.45 ± 9.71 years, the overall prevalence of pre-frailty was reported as 42.9% and frailty as 7.7%. Significant differences were identified between different countries regarding frailty status [4]
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