Authors of a systematic review and meta-analysis of 17 studies involving 129,868 patients with chronic kidney disease (CKD) found a strong association between frailty and cognitive impairment. Compared with physically robust patients, those with frailty had more than threefold higher odds of cognitive impairment (OR, 3.13; 95% CI, 1.92–5.12), while even prefrail patients had significantly elevated odds (OR, 2.70; 95% CI, 1.64–4.45). The overlap was substantial: 42.7% of patients with CKD and cognitive impairment were frail, and 42% of those with CKD and frailty had cognitive impairment. The association also persisted in sensitivity analyses excluding the study with the largest effect and studies using the Mini-Mental State Examination.
The findings suggest that frailty assessment may help identify patients with CKD who warrant closer attention to cognitive health, potentially before overt frailty develops. However, heterogeneity was high (I²=93.98%), with geographic region, frailty assessment method, and covariate adjustment significantly influencing results. Notably, only 2 of the 17 studies adjusted for confounders, and their pooled association was substantially smaller than in unadjusted studies (OR, 1.35 vs 3.69). Because most studies were cross-sectional, the analysis cannot establish that frailty causes cognitive decline. Prospective, well-adjusted studies are needed to clarify the relationship, but the sizable coexistence of these conditions highlights the importance of recognizing both frailty and cognitive vulnerability when managing patients with CKD.
Reference: McCormick B. Frailty may signal elevated risk of cognitive impairment in CKD. AJMC. Published July 29, 2026. Accessed October 6, 2026. https://www.ajmc.com/view/frailty-may-signal-elevated-risk-of-cognitive-impairment-in-ckd
Link: https://www.ajmc.com/view/frailty-may-signal-elevated-risk-of-cognitive-impairment-in-ckd
