Frailty, All-Cause Mortality, and Hospitalization in Patients on Maintenance Hemodialysis: A Systematic Review and Meta-Analysis

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Background/Objective: In recent years, three systematic reviews examining the relationship between frailty and mortality in chronic hemodialysis patients have been published; these reviews employed different inclusion criteria and methodologies, leading to conflicting results. The present study aimed to determine whether frailty is associated with an increased risk of all-cause mortality and hospitalization in patients on maintenance hemodialysis. Methods: The research was conducted in April 2024 using the following databases: MEDLINE via PubMed (1985 to present) and Web of Science Core Collection via Clarivate (1985 to present), with a combination of keywords to capture hemodialysis, frailty, and mortality. Results: We included 23 studies in the analysis, with a total of 10,333 patients (5592 frail and 4741 non-frail). The number of patients in each individual study ranged from 93 to 1652. Adjusted mortality data that accounted for patient characteristics and treatment variables was available from six studies (1034 patients) with a follow-up period of 12 months and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled OR, 3.28; 95% CI, 1.72–6.29). Moderate heterogeneity was observed in this analysis (Chi2 = 14.06, df = 5, (p = 0.02); I2 = 64%). Adjusted mortality data that accounted for patient characteristics and treatment variables was available from 21 studies (8757 patients) with any follow-up period and revealed an increased all-cause mortality risk in frail patients in the random effects model (pooled adjusted OR 2.47; 95% CI, 1.85–3.29). Moderate heterogeneity was observed in this analysis (Chi2 = 55.1, df = 20, (p < 0.0001); I2 = 64%). All-cause hospitalization data was available from 15 studies (6349 patients) with any follow-up period and revealed an increased all-cause hospitalization risk in frail patients in the random effects model (pooled adjusted OR 2.19; 95% CI, 1.72–2.78). Moderate heterogeneity was observed in this analysis (Chi2 = 40.9, df = 13; p < 0.0001; I2 = 68%). No obvious asymmetry, indicating no clear evidence of publication bias, was observed. Conclusions: Frailty is a significant risk factor for all-cause mortality and all-cause hospitalization in patients on maintenance hemodialysis and presents clinicians with important challenges in routine clinical practice.

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