The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis

PurposeCoexistence of frailty and hemodialysis is related to higher risk of hospitalization, falls and mortality. Given the potential reversibility of frailty, reaching the epidemiology of frailty in hemodialysis is of great importance. However, estimates of the prevalence of frailty in patients on hemodialysis vary widely. We tried to synthesize the existing body of literature on the prevalence of frailty in patients on hemodialysis.MethodsWe searched Pubmed, Embase, Web of Science and Cochrane for studies of the prevalence in patients on hemodialysis. The prevalence of frailty was synthesized across eligible studies using a random-effects model. We explored potential origin of heterogeneity in the estimates by meta-regression analysis.ResultsPrevalence range from 6.0 to 82.0% and the pooled prevalence of frailty in patients on dialysis was 34.3% (95% confidence interval (CI) 24.5-44.1%; z=6.87; p=0.00). The pooled estimates of prevalence for patients aged <55, 55-65, and >= 65 were 56.0% (95% CI 28.9-83.2%; z=4.04; p=0.00), 32.3% (95% CI 22.9-41.7%; z=6.74; p=0.00), and 20.3% (95% CI 7.9-32.8%; z=3.2; p=0.00), respectively. There were no significant relationships between frailty in hemodialysis and factors such as years of publication, sample size (continuous), sample size(>500 vs <= 500), diagnostic method (the Fried Frailty vs other), country (Europe & USA vs Asia) and duration of hemodialysis.ConclusionsFrailty influences almost three in ten patients on hemodialysis. Understanding the underlying pathophysiology mechanisms and weakening the impacts of frailty in patients on hemodialysis are called on to action in the future work.