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

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; I-2 = 47%) and per 1 SD increase in HGS (HR = 0.47 95% CI 0.35-0.64; P < 0.0001; I-2 = 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.