Frailty and chronic kidney disease: a systematic review

Objective Frailty is associated with increased vulnerability to poor health. There is growing interest in understanding the association between frailty and chronic kidney disease (CKD). This systematic review explored how frailty is measured in patients with CKD and the association between frailty and adverse outcomes across different stages of renal impairment. Study design Systematic analysis of peer reviewed articles. Data sources Pubmed, Medline, Web of Science and Cochrane were used to identify the articles. Data synthesis Articles published before the 17th of September 2016, that measured frailty in patients with CKD was eligible for the systematic review. Two independent researchers assessed the eligibility of the articles. Quality of the articles was assessed using the Epidemiological Appraisal Instrument. Results The literature search yielded 540 articles, of which 32 met the study criteria and were included in the review (n\ua0=\ua036,076, age range: 50–83 years). Twenty-three (72%) studies used or adapted the Fried phenotype to measure frailty. The prevalence of frailty ranged from 7% in community-dwellers (CKD Stages 1–4) to 73% in a cohort of patients on haemodialysis. The incidence of frailty increased with reduced glomerular filtration rate. Frailty was associated with an increased risk of mortality and hospitalization. Conclusion Frailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes. There are differences in the methods used to assess frailty and this hinders comparisons between studies