Frailty Linked to Mortality, Falls, Hospitalizations in Dialysis Patients

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New research is shedding light on the prevalence of frailty among patients undergoing dialysis, calling attention to its association with mortality, falls, and hospitalization.¹

The systematic review and meta-analysis included 26 articles with frailty prevalence ranging from 12.1% to 82.0%. In addition to being common among patients on dialysis, frailty was linked to a greater risk of adverse outcomes.¹

According to the American Kidney Fund, an estimated 35.5 million people in the US have kidney disease, about 808,000 of whom are living with kidney failure. Although kidney transplantation is widely considered to be the best treatment for end-stage renal disease (ESRD), of the 135,000 people newly diagnosed with kidney failure in 2023, less than 3% were able to receive a transplant before starting dialysis due to the shortage of available donor kidneys.²

More than 557,000 people in the US are on dialysis, which is linked to several side effects and adverse clinical outcomes. However, little is known about the impact of coexisting frailty on outcomes in patients undergoing dialysis.^1,2

“The definition of frailty varies widely, and systematic reviews have yet to examine the literature on the relationship between definitions of frailty and mortality among patients undergoing dialysis,” Yan-Ling Tao, of the department of nursing at Longgang Central Hospital of Shenzhen in China, and colleagues wrote.¹ “Hence, it is of great significance to comprehensively analyze whether frailty has an impact on adverse clinical outcomes among patients undergoing dialysis.”

To explore the association between frailty and adverse outcomes in dialysis patients, investigators systematically searched PubMed, Embase, Cochrane, CNKI, WanFang, and China Science and Technology Journal (VIP) databases from inception until April 2022 for studies meeting the following criteria:

• Prospective or retrospective cohort study or population-based longitudinal study
• Including patients ≥ 18 years of age receiving dialysis
• Use of internationally agreed-upon diagnostic criteria for physical frailty
• Reporting the association between frailty and adverse outcomes consisting of mortality, falls, and hospitalization with the effect size or basic data to calculate these values.

In total, investigators retrieved 2744 relevant studies from the databases, 62 of which met the inclusion criteria and 26 of which were ultimately included for quantitative analysis. Most studies were conducted in the US (n = 11, 42.3%) and China (n = 7, 26.9%). The total sample size was 14,086, ranging from 69 to 2275, with the average age ranging from 44.95 to 78.1 years.¹

In the 26 included articles, the prevalence of frailty ranged from 12.1% to 82.0%. Investigators noted frailty was defined using different assessment tools in different studies, including the Fried phenotype, modified Fried phenotype, FRAIL Scale, Clinical Frailty Scale, and Edmonton Frail Scale.¹

In total, 19 studies reported the impact of frailty on mortality in patients undergoing dialysis. Investigators noted the mortality risk of frail patients on dialysis was 2.18 times greater than those without frailty (hazard ratio, 2.18; 95% CI, 1.76–2.70).¹

Additionally, 9 studies assessed the association between frailty and falls, with pooled results showing frailty increased the risk of falls in patients undergoing dialysis (risk ratio [RR], 1.63; 95% CI, 1.45–1.85). Among 8 studies reporting the impact of frailty on hospitalization in patients undergoing dialysis, the pooled results indicated frailty increased the risk of hospitalization (RR, 1.46; 95% CI, 1.33–1.62).¹

“This review showed that frailty has a high prevalence and is a powerful predictor of mortality, falls, and hospitalization in patients on dialysis,” investigators concluded.¹ “Future studies should focus on exploring a frailty assessment tool suitable for such patients to facilitate early identification of frailty and early intervention, leading to improvement in prognosis and thereby reducing the burden of family and social medical care.”

References

1. ^{He WQ, Zhang XM, Zhang YZ, et al. Association Between Frailty and Mortality, Falls and Hospitalisation Among Patients Undergoing Dialysis: A Systematic Review and Meta-Analysis. Nursing Open. https://doi.org/10.1002/nop2.70150}
2. ^{American Kidney Fund. Quick kidney disease facts and stats. July 19, 2024. Accessed February 6, 2025. https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats}