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Meta-Analysis
. 2025 Jul 8;26(1):365.
doi: 10.1186/s12882-025-04288-9.

Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis

Xinghong Wei #  1 , Junjie Peng #  1 , Renjie Chang  2 , Qin Liu  3
Affiliations
Meta-Analysis

Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis

Xinghong Wei et al. BMC Nephrol. .

Abstract

Objective: Chronic kidney disease (CKD) has become a major challenge in global public health, and China has one of the heaviest burdens of CKD in the world, approximately 89.5% of patients require hemodialysis. Cognitive frailty (CF) is a condition characterized by physical frailty and cognitive impairment while excluding Alzheimer's disease and other dementias. CF is associated with adverse clinical outcomes, including hospitalization, disability, and increased mortality. The purpose of this study was to explore the prevalence and influencing factors of CF in Chinese maintenance hemodialysis (MHD) patients through systematic review and meta-analysis.

Methods: We searched PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP) and Chinese Biomedical Database (CBM) for epidemiological data on CF in Chinese patients undergoing MHD from inception to December 2024. A random-effects model was used to estimate the overall prevalence of CF in Chinese patients undergoing MHD. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate factors associated with CF in Chinese patients undergoing MHD. Stata 15.0 software was used to conduct systematic review and meta-analysis of the prevalence and influencing factors of CF in Chinese patients undergoing MHD.

Results: A total of 16 studies with 5690 Chinese patients undergoing MHD were included. The results of this meta-analysis showed that the prevalence of CF in Chinese patients undergoing MHD was 25%. The results of subgroup analyses showed that the frailty assessment tool (TFI) and education level (≥ College) may be sources of heterogeneity in the prevalence of CF in Chinese patients undergoing MHD. The meta-analysis results indicate that age (> 60, > 75), female, depression (HADS scale), malnutrition, triglycerides, waist circumference, stroke history, fall history, complications, CCI, comorbidities and dialysis age were risk factors for CF. High education level, calf circumference and serum creatinine level were protective factors for CF.

Conclusions: The prevalence of CF in Chinese patients undergoing MHD is high (25%). Therefore, this patient population necessitates early screening and targeted interventions with influencing factors.

Prospero registration number for this study: CRD42023493122CRD42023475424.

Keywords: China; Cognitive frailty; Influencing factors; Maintenance hemodialysis; Meta-analysis; Prevalence.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study is mainly to collect data from various databases for analysis, so this is not applicable. Consent for publication: Not required. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Literatures screening process and results
Fig. 2
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Forest plot of pooled prevalence
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Age (> 60) funnel diagram
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Fall history funnel diagram
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Sensitivity analysis
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Funnel diagram
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Results of the scissification method
See this image and copyright information in PMC

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