Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

Abstract

Background and objectives Older patients reaching ESRD have a higher risk of adverse health outcomes. We aimed to determine the association of functional and cognitive impairment and frailty with adverse health outcomes in patients reaching ESRD. Understanding these associations could ultimately lead to prediction models to guide tailored treatment decisions or preventive interventions.Design, setting, participants, & measurements We searched MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, and COCHRANE for original studies published until February 8, 2016 reporting on the association of functional or cognitive impairment or frailty with adverse health outcome after follow-up in patients reaching ESRD either with or without RRT.Results Of 7451 identified citations, we included 30 articles that reported on 35 associations. Mean age was .60 years old in 73% of the studies, and geriatric conditions were highly prevalent. Twenty-four studies (80%) reported on functional impairment, seven (23%) reported on cognitive impairment, and four (13%) reported on frailty. Mortality was the main outcome measure in 29 studies (97%), and one study assessed functional status trajectory. In 34 of 35 (97%) associations reported, functional or cognitive impairment or frailty was significantly and independently associated with adverse health outcomes. The majority of studies (83%) were conducted in selected patient populations, mainly patients on incident dialysis.Conclusions Functional and cognitive impairment and frailty in patients reaching ESRD are highly prevalent and strongly and independently associated with adverse health outcomes, and they may, therefore, be useful for risk stratification. More research into their prognostic value is needed.

Depression and Physical Frailty Have Additive Effect on the Nutritional Status and Clinical Outcome of Chinese Peritoneal Dialysis

“…Notably, depressive symptoms are present in 27.5% patients in this study, but in over 50% of Chinese PD patients in previous reports [10,33]. Similarly, cognitive impairment is present in over 20% of patients receiving hemodialysis [9] as well as PD [10], but is less than 8% in the present study. The cause of this discrepancy in prevalence is unknown, but may reflect the difference in background comorbidity load and eligibility criteria of dialysis across different countries.…”

“…Traditionally, frailty refers to a clinical syndrome involving unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity [7]. It is present in around 35% of hemodialysis patients [8] and, regardless of age, frailty is a strong independent predictor of mortality and number of hospitalizations [8,9]. Cognitive impairment is present in over 20% of dialysis patients [9,10], and is associated with increased risks of mortality and adverse clinical outcome [9,11].…”

“…It is present in around 35% of hemodialysis patients [8] and, regardless of age, frailty is a strong independent predictor of mortality and number of hospitalizations [8,9]. Cognitive impairment is present in over 20% of dialysis patients [9,10], and is associated with increased risks of mortality and adverse clinical outcome [9,11]. Similarly, depressive symptoms are present in over 50% of PD patients [10] and is associated with excessive morality and represents a risk factor of peritonitis [12,13].…”

Challenges of population ageing: putting frailty as a cornerstone of health and social care systems

“…There are also increasing numbers of publications describing the role of frailty assessment in investigation and management of diseases in various specialties such as oncology, cardiology, and nephrology [17][18][19]. Frailty screening has also been described in Accident and Emergency Departments [20][21][22].…”

Dialytic hemodynamics are associated with changes in gait speed

“…6 Functional impairment in HD patients has significant impact including increased risk of falls and hospitalizations, higher mortality and worse quality of life. 3,7 …”