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

Hyeon-Ju Lee,Youn-Jung Son

doi:10.3390/ijerph18073471

Abstract

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.

Highlights

Chronic kidney disease (CKD) is a progressive loss in kidney function and an irreversible clinical syndrome that is characterized by the kidney’s failure to filter waste products and remove excessive fluid from the body [1]
We organized the research question according to the “PICO” format [25], which was: What is the prevalence and associated factors of frailty (Interest) and the association of frailty and mortality (Outcome) in patients with End-stage renal disease (ESRD) undergoing hemodialysis (Patient), compared with patients without hemodialysis-dependent ESRD (Comparator)? Our systematic review was conducted by reviewing the literature in electronic databases such as PubMed, Embase, CINAHL, Web of Science, and Cochrane Library for cohort studies published until 30 November 2020
Medical Subject Heading (MeSH) and non-MeSH keywords were used in the search strategy based on our research question: “frailty or frail”, “dialysis or hemodialysis”, “chronic kidney disease or CKD or end-stage renal disease or ESRD”, and “mortality or death or outcome”

Summary

Introduction

Chronic kidney disease (CKD) is a progressive loss in kidney function and an irreversible clinical syndrome that is characterized by the kidney’s failure to filter waste products and remove excessive fluid from the body [1]. End-stage renal disease (ESRD) represents a serious public health problem fueled by aging populations and a pandemic of chronic noncommunicable diseases [3,4]. Overall mortality rate of the ESRD population is improving, the mortality rate has been reported to be up to 30% within the first year of transition from. To maintain daily life activities, renal replacement therapy is commonly used for ESRD in clinical practice, including hemodialysis, peritoneal dialysis, and kidney transplantation [7]. Kidney transplantation is the optimal choice of ESRD treatment, challenges such as immunosuppression and organ donor shortage remain an issue [8,9]

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