Physical function and all-cause mortality in patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis

Abstract

Purpose: The loss of skeletal muscle mass and muscle strength is common in patients suffering from chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing dialysis. The purpose of this study was to conduct a meta-analysis to explore the relationship between physical functional performance and all-cause mortality in CKD and ESRD patients undergoing dialysis.

Methods: A systematic literature search was conducted on an electronic database up to January 2022, and all data were analyzed using RevMan5 (version 5.3).

Results: Totally, 19 studies involving 6908 patients were enrolled for analysis. Patients with poor physical functional performance in the handgrip strength (HGS) (hazard ratio [HR] = 1.99, P < 0.00001), gait speed (HR = 2.45, P = 0.0005), 6 m walk test (HR = 2.94, P < 0.01), and timed up and go test (HR = 1.69, P = 0.02) showed increased risk of all-cause mortality than those with good physical functional performance. In continuous analyses, both per 1 kg increase in HGS (95% CI 0.94-0.98; P < 0.00001; I² = 47%) and per 1 SD increase in HGS (HR = 0.47 95% CI 0.35-0.64; P < 0.0001; I² = 35%) were significantly associated with lower all-cause mortality.

Conclusion: The present meta-analysis demonstrated that poor physical function outcomes, including grip strength, gait speed, 6MWT, and TUG test, were significantly associated with high all-cause mortality in patients with CKD and ESRD.

Keywords: Chronic kidney disease; Dialysis; Mortality; Physical function.