title: Association of frailty and physical function in patients with non-dialysis CKD: a systematic review.
abstract: BACKGROUND
  Frailty is a condition characterized by a decline in physical function and functional capacity. Common symptoms of frailty, such as weakness and exhaustion, are prevalent in patients with chronic kidney disease (CKD). The increased vulnerability of frail patients with coexisting CKD may place them at a heightened risk of encountering additional health complications. The purpose of this systematic review was to explore the link between frailty, CKD and clinical outcomes.
  
  
  METHODS
  We searched for cross sectional and prospective studies in the general population and in the CKD population indexed in EMBASE, Pubmed, Web of Science, CINAHL, Cochrane and Ageline examining the association between frailty and CKD and those relating frailty in patients with CKD to clinical outcomes.
  
  
  RESULTS
  We screened 5,066 abstracts and retrieved 108 studies for full text review. We identified 7 studies associating frailty or physical function to CKD. From the 7 studies, we identified only two studies that related frailty in patients with CKD to a clinical outcome. CKD was consistently associated with increasing frailty or reduced physical function [odds ratios (OR) 1.30 to 3.12]. In patients with CKD, frailty was associated with a greater than two-fold higher risk of dialysis and/or death [OR from 2.0 to 5.88].
  
  
  CONCLUSIONS
  CKD is associated with a higher risk of frailty or diminished physical function. Furthermore, the presence of frailty in patients with CKD may lead to a higher risk of mortality. Further research must be conducted to understand the mechanisms of frailty in CKD and to confirm its association with clinical outcomes.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Walker
authors.forename: Kamalpreet
authors.initials: K
authors.lastname: Gill
authors.forename: Kerry
authors.initials: K
authors.lastname: Macdonald
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Clara J
authors.initials: CJ
authors.lastname: Bohm
authors.forename: Leroy J
authors.initials: LJ
authors.lastname: Storsley
authors.affiliation: Seven Oaks Hospital, Winnipeg, Manitoba, Canada. ntangri@sogh.mb.ca.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000401:mortality*; D010809:Physical Fitness; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D012307:Risk Factors; D015996:Survival Rate