Association Between Frailty and Cognitive Impairment in Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

BACKGROUND

The literature has reported conflicting findings regarding the association between frailty and cognitive impairment in patients with chronic kidney disease (CKD). This systematic review and meta-analysis examined the association between frailty and cognitive impairment in patients with CKD.

METHODS

A comprehensive search of Embase, PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted from database inception to February 2026. Eligible studies comprised cross-sectional, cohort, case-control, randomized controlled trials, and quasi-experimental studies that reported associations between frailty and cognitive impairment in patients with CKD, with no time or language restrictions.

RESULTS

A total of 17 studies (9 cross-sectional and 8 cohort) involving 129,868 patients with CKD (mean age 60.88 years) were included in the meta-analysis. The findings indicated that patients with frailty with CKD had significantly higher odds of cognitive impairment than robust patients (odds ratio = 3.13, 95% CI 1.92-5.12). Heterogeneity in association size was influenced by study region, frailty measurement methods, and whether covariate adjustments were made during data analysis (all p < 0.05).

CONCLUSIONS

This systematic review and meta-analysis identified a significant association between frailty and cognitive impairment in patients with CKD. Future prospective cohort studies should assess the causal relationships between frailty and cognitive impairment in this population.

CLINICAL RELEVANCE STATEMENT: This study systematically assessed the association between frailty and cognitive impairment in patients with CKD, addressing inconsistent findings in prior research. The results highlight the importance of implementing targeted interventions, particularly for nonfrail CKD patients, to reduce the burden of cognitive impairment and improve patients' outcomes.