title: Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD-A Systematic Review.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Departments of Nephrology.|Gerontology and Geriatrics, and.
authors.forename: Marije H
authors.initials: MH
authors.lastname: Kallenberg
authors.affiliation: Departments of Nephrology.
authors.forename: Hilda A
authors.initials: HA
authors.lastname: Kleinveld
authors.affiliation: Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.|Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
authors.affiliation: Departments of Nephrology.
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.affiliation: Departments of Nephrology.|Department of Nephrology, Haga Hospital, The Hague, The Netherlands; and.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: van Buren
authors.affiliation: Gerontology and Geriatrics, and.|Institute for Evidence-Based Medicine in Old Age, Leiden, The Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Mooijaart
mesh_terms: D000203:Activities of Daily Living; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D000073496:Frailty / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality; D051346:Mobility Limitation
keywords: Cognition Disorders; Follow-Up Studies; Humans; Kidney Failure, Chronic; Outcome Assessment (Health Care); Renal Replacement Therapy; cognitive impairment; dialysis; end stage renal disease; frail elderly; functional impairment; renal dialysis