Chinese Journal of Blood Purification

12 February 2022, Volume 21 Issue 02 Previous Issue    Next Issue

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Home hemodialysis machine technology: a global overview 2022, 21 (02):  73-76.  doi: 10.3969/j.issn.1671-4091.2022.02.001 Abstract ( 598 )   PDF (1299KB) ( 319 )   【Abstract】At present, there are only few cases of home hemodialysis in Chinese mainland, and the machines uses are traditional dialysis machine. In Europe and America, most home hemodialysis patients use the machines specially designed for home dialysis, which are more compact and easy to operate. This paper will briefly describe the home dialysis machine and related technologies that have been used abroad. Metrics

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Recent advances in research on protein binding toxins removal 2022, 21 (02):  77-80.  doi: 10.3969/j.issn.1671-4091.2022.02.002 Abstract ( 371 )   PDF (577KB) ( 302 )   【Abstract】The clearance capacity of uremic toxin is severely impaired in patients with chronic kidney disease (CKD) than that in normal people. With the accumulation of uremic toxins, many systems including the cardiovascular system are damaged in CKD patients. Blood purification can remove most uremic toxins through diffusion, convection and adsorption. However, the removal rates for protein binding toxins are limited, which affects the prognosis of CKD patients. In this paper, we reviewed the progress of protein binding toxins and cardiovascular disease in CKD patients, and the clearance of protein binding toxins by blood purification. In this paper, we reviewed the relationship between protein binding toxins and the progress of cardiovascular disease in CKD patients, and the effect of blood purification methods on the removal of protein bining toxins. Metrics

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Application of high cut-off membranes with continuous renal replacement therapy in septic acute kidney injury 2022, 21 (02):  81-84.  doi: 10.3969/j.issn.1671-4091.2022.02.003 Abstract ( 212 )   PDF (500KB) ( 147 )   【Abstract】With the Innovation of continuous renal replacement therapies (CRRT) technology and dialysis membrane, the treatment methods for sepsis complicated with acute kidney injury have been gradually diversified in recent years. Among those innovation, High cut-off (HCO) membrane have more promising benefits in the removal of inflammatory factors which could not be effectively removed by the traditional high-flux filters. HCO membrane is expected to be more selective in the clinical practice to remove large molecular weight inflammatory mediators, thus providing effective intervention for systemic inflammation status by blood purification in addition to anti-infection therapy. Our review focuses specifically on the clinical application of HCO therapy, including published studies focused on the removal of inflammatory cytokines by HCO membrane and its improvement in prognosis. We also summarize the differences of those published studies and potential applications of HCO membrane. Metrics

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Clinical features, diagnosis and treatment of pleuroperitoneal communication in peritoneal dialysis patients 2022, 21 (02):  85-88.  doi: 10.3969/j.issn.1671-4091.2022.02.004 Abstract ( 675 )   PDF (455KB) ( 115 )   【Abstract】Objective To explore the clinical features, diagnosis and treatment of pleuroperitoneal communication in peritoneal dialysis (PD) patients. Methods The PD patients diagnosed with pleuroperitoneal communication during January 1, 2006 to September 30, 2021 and treated in the PD Center of Peking University People's Hospital were enrolled in this study. General information, PD procedures, symptoms and signs, laboratory results, diagnosis methods, treatment and outcome were collected and analyzed. Results ①Five PD patients with pleuroperitoneal communication were diagnosed with the incidence of 0.96%. ②Pleuroperitoneal communication occurred in the period of increasing dialysate dwelling dose during the first 3~13 weeks of PD and at the right side in all of the 5 cases. Four of the five cases were females. Female, older age and low body surface area may be the risk factors. The major clinical manifestations included chest tightness, dyspnea and decreased ultrafiltration volume. ③ Chest X-ray revealed moderate to large pleural effusion in right side. Glucose concentration in pleural fluid higher than that in blood, methylene blue injected into abdominal cavity, and CT peritoneography were the methods to confirm the diagnosis. ④Once diagnosed, PD should be interrupted immediately and changed to hemodialysis temporarily or permanently. In some cases, PD may be continued beginning from lower dialysate dwelling dose and gradual increase of the dose to reconstitute the long- term PD. Conclusions Pleuroperitoneal communication is a rare complication of PD, frequently occurring in the period of increasing dialysate dwelling dose at the early stage of PD. CT peritoneography has been the most simple and effective diagnosis method. After diagnosis, PD should be switched to hemodialysis temporarily or permanently, or reconstituted starting from lower dialysate dwelling dose and gradual increase of the dose. If possible, surgical treatment is an effective measure for this complication. To prevent the occurrence of pleuroperitoneal communication in PD patients with the risk factors, symptoms and signs relating to pleuroperitoneal communication and changes of intraperitoneal pressure should be closely monitored in the period of increasing dialysate dose at the early stage of PD, and the dialysate dwelling dose should be reduced when necessary. Metrics

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The cause of death and its related information in hemodialysis patients in China - enlightenment from the DOPPS study 2022, 21 (02):  89-93.  doi: 10.3969/j.issn.1671-4091.2022.02.005 Abstract ( 1037 )   PDF (430KB) ( 681 )   【Abstract】Although hemodialysis (HD) can improve the life expectancy of end stage renal disease (ESRD) patients, the risk of death is still significantly higher in HD patients than in general population. The purpose of this study was to explore the cause of death and its related information in HD patients in the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods DOPPS is an international, prospective and observational study. China participated in the DOPPS 5 study (2012～2015) and has completed the follow-up of the cohort. A total of 1,427 patients were enrolled in the China DOPPS 5 study. Their demographics, primary cause of ESKD, comorbidities, dialysis prescription, laboratory examination results, and date, cause and other related information of death were recruited. The primary cause, date and place of death were then defined. Results A total of 1,427 HD patients were enrolled in the China DOPPS 5 study, including 473 cases in Beijing, 454 cases in Guangzhou and 500 cases in Shanghai. The average age of the patients was 59.4+14.9 years old, 55% were males, and 25.1% had diabetes. The mean follow-up period was 1.9 years (1.1, 2.1 years). During the follow-up period, 205 patients died, with the overall mortality of 14.4% and the annual average mortality of 8.8%. In the death patients, the median age was 70 (59, 79) years old, 56.1% were males, and the median dialysis vintage was 2.5 (1.0～5.0) years. The number of death patients in Beijing, Guangzhou and Shanghai were 67, 67 and 71 cases respectively, with the annual average mortality of 7.9%,10.0% and 8.6% respectively. The top three causes of death in HD patients were cerebrovascular events (19.3%, including ischemic stroke), congestive heart failure (18.2%) and pulmonary infection (11.6%); 105 cases died of cardiovascular diseases, accounting for 51.2% of the death patients. There were gender differences in the ranking of the main causes of death. In the died patients, 70.8% died in hospital and 27.0% died at home; HD treatment continued before death in 79.8% patients, and discontinued before death in 20.2%; 62.9% cases received hospice care before death; the risk time of death in a day was within 10pm～6am. Conclusion In the China DOPPS 5 study, the average annual mortality was 8.8%. The main cause of death was cardiovascular events. Among the single cause of death, cerebrovascular events (including ischemic stroke), congestive heart failure and pulmonary infection were the most common causes of death, and the causes of death seemed to be gender different. The terminal stage was present in most death patients, and 1/4 of death happened at home. Without medical intervention, the risk time of death in a day was from late night to early morning. Metrics

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The correlation between platelet/lymphocyte ratio and all-cause death in patients with maintenance hemodialysis 2022, 21 (02):  94-97.  doi: 10.3969/j.issn.1671-4091.2022.02.006 Abstract ( 284 )   PDF (484KB) ( 205 )   【Abstract】Objective To explore the effect of platelet/lymphocyte ratio (PLR) on all-cause mortality in maintenance hemodialysis (MHD) patients. Methods The MHD patients with regular hemodialysis for more than 3 months and stable condition and treated in the Hemodialysis Center, Dongfeng General Hospital of Traditional Chinese Medicine, Jinzhou Medical University were retrospectively analyzed. PLR was calculated from the results of blood routine. The patients were divided into four groups (Q1~Q4 group) based on quartile range. Kaplan-Meier method and log-rank test were used to compare the survival rates among the 4 groups. COX regression model was used to analyze the risk factors for all-cause death in MHD patients. Results A total of 283 MHD patients were enrolled in this study, with the average age of 63.88±15.40 years old, and the median dialysis vintage of 3.24 (1.82, 6.05) months. Kaplan-Meier survival curve showed that patients with baseline PLR ≥196.44 had higher all-cause mortality (log-rank test, χ2=53.128, P＜0.001). After adjustment for multiple confounding factors, PLR was still linked to the risk of all- cause death. The risk of all- cause death in the Q4 group was 3.776 times higher than that in the Q1 group (HR=4.776, 95% CI 1.580～14.437, P=0.006). Conclusion Higher PLR is associated with higher all-cause mortality in MHD patients and is a strong predictor for all-cause mortality in MHD patients. Metrics

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The application performance of urine quantitative analysis system based on computer vision in the screening of albuminuria 2022, 21 (02):  98-102.  doi: 10.3969/j.issn.1671-4091.2022.02.007 Abstract ( 270 )   PDF (489KB) ( 286 )   【Abstract】Objectives This study aimed to evaluate the diagnostic performance of a computer visionbased urine quantitative analysis system for albuminuria screening. Methods A total of 143 participants with various levels of urinary albumin to creatinine ratio (uACR) recruited from the patients subjected to urinary analysis at Peking University First Hospital during February 2021 were included in this study. Randomly selected spot urine samples were collected from these participants and measured using both clinical laboratory method and the computer vision-based urine quantitative analysis system. With the results of clinical laboratory method as golden criteria, the diagnostic performance of the computer vision-based urine quantitative analysis system in albuminuria screening was evaluated in terms of validity, reliability, predictive value, and area under the receiver operating curve (AUC). Results In the 143 participants, albuminuria A1, A2 and A3 accounted for 59 case (41.3%), 39 cases (27.3%) and 45 cases (31.5%), respectively. The computer visionbased urine quantitative analysis system achieved better performance in albuminuria screening in terms of validity, reliability, predictive value and AUC. When albuminuria A1 was set as negative albuminuria and albuminuria A2 and A3 were set as positive albuminuria, the urine quantitative analysis system achieved an accuracy of 88.8%, a sensitivity of 94.0% and a specificity of 81.4%; the positive and negative predictive values were 87.8% and 90.6%, respectively, with an AUC of 0.962. Conclusions The computer vision-based urine quantitative analysis system had better diagnostic performance in albuminuria screening with higher accuracy, sensitivity and AUC. Due to its convenience and low cost, the computer vision-based urine quantitative analysis system is especially suitable for the preliminary screening of chronic kidney disease in large scales of population. Metrics

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Predialysis plasma osmolality for the prediction of frequent- intradialytic hypotension in hemodialysis patients  2022, 21 (02):  103-106.  doi: 10.3969/j.issn.1671-4091.2022.02.008 Abstract ( 239 )   PDF (445KB) ( 126 )   【Abstract】Objective To evaluate the value of pre-dialysis plasma osmolality for the prediction of frequent-intradialytic hypotension (f-IDH) in hemodialysis (HD) patients. Methods A total of 100 HD patients with f-IDH treated in Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medicine University from June 2020 to May 2021 were enrolled as the case group. By frequency matching method, 100 HD patients without f-IDH with the ratios of age, gender and diabetes comparable to those in the case group were enrolled as the control group. The risk factors for f-IDH were analyzed by logistic regression analysis, and the diagnostic value of pre-dialysis plasma osmolarity for f-IDH was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). Results In the case group, serum parathyroid hormone (Z=-2.889, P=0.004), triglyceride (Z=-3.422, P=0.001), pre- dialysis plasma osmolarity (t=2.642, P=0.009), and average ultrafiltration volume/dry weight (t=3.700, P＜0.001) were higher than those in the control group, while serum albumin (t=2.402, P=0.018) was lower than that in the control group. Binary logistic regression analysis revealed that lower albumin (OR=0.847, 95% CI 0.723～0.992, P= 0.040), higher predialysis plasma osmolarity (OR=1.255, 95%CI 1.00～1.112, P=0.035) and higher average ultrafiltration volume/ dry weight (OR=1.719, 95% CI 1.225～2.412, P=0.002) were the independent risk factors for f-IDH in HD patients. ROC analysis showed that the AUC of pre-dialysis plasma osmolarity for the diagnosis of f-IDH was 0.702, with the cut-off value of 304.65 mOsm/Kg.H2O. Conclusion Higher pre-dialysis plasma osmolarity was an independent risk factors for f-IDH and can be used as a predictor for f-IDH in HD patients. Metrics

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Study on the expression and activity of Apelin-13 and angiotensin Ⅱ in autologous arteriovenous fistula stenosis 2022, 21 (02):  107-110.  doi: 10.3969/j.issn.1671-4091.2022.02.009 Abstract ( 109 )   PDF (527KB) ( 79 )   【Abstract】Objective To study the expression and activity of angiotensin II receptor-like 1 endogenous ligand 13 (Apelin-13) and angiotensin Ⅱ (AngⅡ) in autologous arteriovenous fistula (AVF). Methods Ninety patients on hemodialysis were selected and divided into stenosis group (n=45) and normal group (n=45) according to the presence or absence of AVF stenosis. Forty-five patients with chronic kidney disease admitted to the hospital in the same period were selected as the control group. Serum levels of Apelin-13, AngⅡ, and nitric oxide (NO) in the three groups were compared. The correlation between Apelin-13, AngⅡ and NO levels was analyzed in stenosis group. ROC curve was used to analyze the diagnostic value of Apelin-13 and AngⅡ for AVF stenosis. Human umbilical vein endothelial cells (HUVECs) were used to analyze the expression of NO, phosphorylated endothelial nitric oxide synthase (peNOS) and endothelial nitric oxide synthase (eNOS) after stimulation with AngⅡ (group A), Apelin-13 (group B) and AngⅡ combined with Apelin-13 (group C). Results The differences of serum Apelin-13, AngⅡ, and NO levels were statistically significant among steno-sis group, normal group and control group (F=31.125, 64.720 and 21.024 respectively, P= 0.001). In stenosis group, Apelin-13 was positively correlated with NO (r=0.447, P<0.001), and AngⅡ was negatively correlated with NO (r=-0.611, P<0.001). The AUC of Apelin-13 for the diagnosis of AVF stenosis was 0.780 (95% CI=0.679～0.880), and the AUC of AngⅡ for the diagnosis of AVF stenosis was 0.844 (95% CI=0.760～0.927); no significant difference was found between AUC values of Apelin-13 and AngⅡ for the diagnosis of AVF stenosis (Z=0.959, P=0.337). The differences of NO and peNOS levels were statistically significant among groups A, B and C (F=31.361 and 11.079 respectively, P<0.001). Conclusion Serum Apelin-13 and Ang Ⅱ levels were correlated with NO level in patients with AVF stenosis. Apelin-13 may regulate the eNOS/NO signaling pathway by antagonizing Ang Ⅱ to inhibit endothelial cell apoptosis, reduce vascular endothelial cell damage and relieve the degree of AVF stenosis in hemodialysis patients. Metrics

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Interpretation on the clinical practice guidelines and expert consensus about exercise rehabilitation in chronic kidney disease 2022, 21 (02):  111-114.  doi: 10.3969/j.issn.1671-4091.2022.02.010 Abstract ( 344 )   PDF (406KB) ( 421 )   【Abstract】Physical activity and exercise have been recognized gradually as“medicine”for the management of chronic kidney disease. On April 8, 2021, British Renal Society published the“Clinical Practice Guideline: Exercise and Lifestyle in Chronic Kidney Disease”, which provides guidance on physical activity/exercise, weight management, and other lifestyle consideration in non-dialysis chronic kidney disease, hemodialysis and kidney transplant recipients. This paper interprets the module of physical activity/exercise combined with the consensus of experts in our country. Metrics

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Research progress of peritoneal dialysis in patients with liver cirrhosis complicated with end-stage renal disease 2022, 21 (02):  115-118.  doi: 10.3969/j.issn.1671-4091.2022.02.011 Abstract ( 274 )   PDF (364KB) ( 81 )   【Abstract】The choice of renal replacement treatment in patients with liver cirrhosis and end-stage renal disease is still controversial. This review will discuss the pros and disadvantages of different renal replacement treatment modes in patients with cirrhosis and end- stage renal disease, focusing on the application of peritoneal dialysis in this population. Metrics

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Research progress in exercise intervention of autologous arteriovenous fistula in patients with maintenance hemodialysis 2022, 21 (02):  119-122.  doi: 10.3969/j.issn.1671-4091.2022.02.012 Abstract ( 171 )   PDF (428KB) ( 225 )   【Abstract】Autogenous arteriovenous fistula (AVF) is the main blood access pathway for patients with maintenance hemodialysis (MHD). However, the lagged maturation, stenosis and thrombosis of AVF are great challenges for both doctors and patients. Intimal hyperplasia is the main pathophysiological factor of AVF stenosis. In addition to endothelial dysfunction, local hydrodyna-mics also play an important role. Studies have shown that exercise intervention and rehabilitation training after AVF operation can facilitate its maturation and longer service life of AVF. This paper reviews the effects of different exercise modes on vascular function before and after AVF operation, and the research progress and pathophysiological mechanism in improvement of vascular patency rate, in order to provide economical, safe and effective intervention methods for clinical practice. Metrics

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Anesthesia for percutaneous angioplasty in maintenance hemodialysis patients 2022, 21 (02):  123-125.  doi: 10.3969/j.issn.1671-4091.2022.02.013 Abstract ( 413 )   PDF (371KB) ( 118 )   【Abstract】Arteriovenous fistula is the recommended vascular access for maintenance hemodialysis patients. Percutaneous angioplasty(PTA) is an important means to treat the complications of arteriovenous fistula and has become the first-line treatment recommended by the guidelines at present. Percutaneous angioplasty session is often accompanied by severe pain, which affects the medical experience of patients. Appropriate anesthesia and sedation can reduce the pain. However, due to the particularity of uremic patients, there has been no unified conclusion on the anesthesia choice of percutaneous angioplasty. This paper reviews various anesthesia methods in previous percutaneous angioplasty in order to draw a tendentious conclusion. Metrics

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Influencing factors relating to the accidental exit of tunneled-cuffed catheter in maintenance hemodialysis patients 2022, 21 (02):  126-130.  doi: 10.3969/j.issn.1671-4091.2022.02.014 Abstract ( 209 )   PDF (503KB) ( 118 )   【Abstract】Objective To investigate the influencing factors relating to the accidental exit of tunneledcuffed catheter (TCC) in patients with maintenance hemodialysis (MHD). Methods Twenty-one MHD patients having the accidental exit of TCC during January 2016 to June 2021 treated in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. Seventy- seven cases with TCC fixed in place were obtained by the system sampling method as the control group. Clinical data and laboratory results as the observation items were collected and compared between the two groups. Logistic regression was used to analyze the relevant risk factors for accidental exit of TCC. Results There were 445 cases who met entry criteria in the period, and the rate of accidental exit was 4.72%. Multivariate regression analysis suggested that suture reaction at the TCC exit site (OR=9.289, 95% CI: 1.767～48.841, P=0.008), neutrophil to lymphocyte ratio (NLR) (OR=1.659, 95% CI: 1.053～2.613, P= 0.029), serum albumin (ALB) (OR=0.813, 95% CI:0.671～0.986, P=0.035) and serum phosphate (P) (OR=5.528, 95% CI: 1.486～20.560, P=0.011) were the independent risk factors for accidental exit of TCC. Conclusions Suture reaction at the TCC exit site, NLR, ALB and P are the independent risk factors relating to accidental exit of TCC in MHD patient. Therefore, effective control of local and systemic inflammation, improvement of nutritional status, and active control of blood phosphate may have clinical significance for preventing accidental exit of TCC. Metrics

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Treatment strategy of tunneled cuffed catheter dysfunction in hemodialysis patients 2022, 21 (02):  131-135.  doi: 10.3969/j.issn.1671-4091.2022.02.015 Abstract ( 237 )   PDF (669KB) ( 228 )   【Abstract】Objective To explore the evaluation and treatment strategies of tunneled cuffed catheter dysfunction in hemodialysis patients. Methods The characteristics, treatment methods and curative effects of 80 cases with tunneled cuffed catheter dysfunction treated in the Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine from January 2016 to December 2020 were retrospectively analyzed. Results Eighty patients totally subjected to 92 times of the treatment were enrolled in this study. Thirty-one were males and 49 were females. The average age was (63.45±13.7) years old. Radiography showed central venous stenosis in 75 cases. Autologous arteriovenous fistula was established in 8 cases, and arteriovenous graft was established in 4 cases in upper limb and in 3 cases in lower limb; all of the established fistulas were used normally. Thrombolytic therapy was used for 22 times in 14 cases, the average patency time was (10.22±9.62) months, and two of them had to change the catheter in situ because of recurrent catheter dysfunction in a short period of time. Fifty-two cases underwent catheter replacement in situ, and 3 cases underwent catheter replacement ectopically. The average follow-up time was (49.5±3.8) months. The patency rates were 93.2%, 82.7% and 74.0% after the treatment for 12 months, 24 months and 36 months respectively. Conclusion The treatment of tunneled cuffed catheter dysfunction should be individualized based on comprehensive evaluation of the patients so as to prolong the dialysis life of the patients. Metrics

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Baseline characteristics of arm vessels evaluated by ultrasonography in end stage renal disease patients 2022, 21 (02):  136-139.  doi: 10.3969/j.issn.1671-4091.2022.02.016 Abstract ( 234 )   PDF (770KB) ( 194 )   【Abstract】Objective To explore the baseline characteristics of arm vessels evaluated by ultrasonography in patients with end stage renal disease so as to provide the reference for creation of arteriovenous fistula. Methods A total of 307 patients with end stage renal disease treated in Sir Run Run Shaw Hospital from July 2016 to May 2020 were enrolled in this study. Duplex ultrasonography was used to evaluate the baseline characteristics of arm vessels, including internal diameter, intima-media thickness, calcification and hemodynamic parameters. Results The mean internal diameters (mean±SD) of forearm cephalic vein, upper arm cephalic vein, forearm basilic vein, upper arm basilic vein, median cubital vein and cubital perforating vein were (2.6± 0.9)mm, (3.6±1.4)mm, (2.4±0.8)mm, (4.6±1.1)mm, (2.9±1.7)mm and (3.1±1.0)mm, respectively. The mean internal diameters (mean± SD) of upper brachial artery, lower brachial artery, upper radial artery, lower radial artery, upper ulnar artery, lower ulnar artery were (4.1±0.9)mm, (4.1±0.7)mm, (2.7±0.6)mm, (2.0±0.5)mm, (3.6± 0.6)mm and (1.7±0.5)mm, respectively. The incidences of calcification in brachial artery, radial artery and ulnar artery were 8.8%, 15.9% and 23.4%, respectively. The mean peak systolic velocities (mean±SD) in brachial artery, radial artery and ulnar artery were (63.7±19.2)cm/s, (60.6±20.9)cm/s and (58.2±20.4)cm/s, respectively. Resistance indexes were all (0.9±0.1). The mean flow volume (mean±SD) in brachial artery was (55.1±36.9)ml/min. Conclusion Duplex ultrasonography has the advantage of noninvasive method to evaluate the baseline characteristics of arm vessels. Our study shows that the percentages of internal diameters meeting the basic requirement of arteriovenous fistula creation (≥2.0mm) in forearm cephalic vein, upper arm cephalic vein, forearm basilic vein, upper arm basilic vein, median cubital vein and cubital perforating vein were 79.5%, 88.7%, 70.7%, 98.6%, 73.3% and 88.9%, respectively; the percentages of internal diameters meeting the basic requirement of arteriovenous fistula creation (≥1.5mm) in brachial artery, radial artery and ulnar artery were 100.0%, 89.6% and 66.8%, respectively. Metrics

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The prevalence of frailty in patients with chronic kidney disease: a meta-analysis 2022, 21 (02):  140-144.  doi: 10.3969/j.issn.1671-4091.2022.02.017 Abstract ( 183 )   PDF (1024KB) ( 109 )   【Abstract】Objective To systematically review the prevalence of frailty in chronic kidney disease (CKD) patients. Methods The Cochrane Library, PubMed, Embase, Web of Science and CNKI, VIP, Wan-Fang, CBM databases were searched to collect studies on prevalence of frailty in CKD patients from inception to March 30, 2021. Meta-analysis was performed by using Stata 16.0. Result A total of 30 studies which included 9,496 participants were analyzed. Meta-analysis showed that the prevalence of frailty in CKD patients was 32.5% (ES=0.325, 95% CI: 0.261~0.390, P<0.001), and the prevalence of pre- frailty was 39.6% (ES=0.396, 95% CI: 0.348~0.444, P<0.001). Conclusion The prevalence of frailty and pre-frailty was higher in CKD patients. The prevalence of frailty was related to geographic regions, gender, treatment methods and assessment tools. Therefore, medical staff should pay more attention to identify frailty in CKD patients, and formulate specific intervention plans for them to delay the occurrence and progress of frailty. Metrics