Prevalence of frailty in end-stage renal disease: a systematic review and meta-analysis

Gotaro Kojima

The purpose of this study is to perform a systematic review and meta-analysis on prevalence of frailty among patients with end-stage renal disease (ESRD). ESRD is associated with malnutrition, chronic inflammation, acidemia, impaired hormonal changes, and low physical activity, all of which can directly and indirectly contribute to the development of frailty. Coexistence of ESRD and frailty has been shown to increase risks of adverse health outcomes. Given potential reversibility of frailty, it is important to examine frailty status in this high-risk population. Three databases (EMBASE, Medline, and CINAHL) were systematically searched for studies providing cross-sectional data of prevalence of frailty defined by cardiovascular health study (CHS) criteria among ESRD patients. Meta-analysis calculated pooled prevalence of frailty according to modifications of CHS criteria. Of 837 studies identified through the systematic review, seven studies were included. Three studies used both objectively measured and self-reported CHS criteria, and two studies each used only either criteria. Pooled prevalence of frailty was 36.8% (five studies: 95% CI = 29.9-44.1%, I (2) = 82.6%, p < 0.001) and 67.0% (five studies: 95% CI = 58.7-74.7%, I (2) = 96.5%, p < 0.001) according to the objectively measured and self-reported CHS criteria, respectively. More than one-third of ESRD patients were frail based on the objectively measured CHS criteria, and that prevalence of frailty almost doubled with the CHS criteria substituting self-reported physical function questionnaire score for objective measurements. Given substantial difference in prevalence of frailty depending on the modifications to CHS criteria, this information should be taken into account when evaluating frailty status among ESRD population.