Electromyographic findings and frailty in hemodialysis vs peritoneal dialysis patients

Background To compare the effects of hemodialysis (HD) and peritoneal dialysis (PD) on peripheral nervous system function and frailty in non-diabetic end-stage renal disease (ESRD) patients.Methods This prospective, single-center, cross-sectional study consecutively enrolled 88 non-diabetic ESRD patients (HD: n = 45, PD: n = 43) receiving dialysis for ≥3 months at Bursa City Hospital between 1 May and 16 September 2025. All underwent neurological examination and nerve conduction studies. Frailty was assessed using the Fried Frailty Phenotype (FFP), classifying patients as robust (0), pre-frail (1–2) or frail (≥3). Multivariable linear regression identified independent correlates of frailty score.Results Median age was 57 (HD) versus 52 years (PD) (p = 0.077). HD patients had higher potassium (5.1 ± 0.7 vs 4.7 ± 0.6 mmol/L, p = 0.025) and ferritin (763 vs 406.5 ng/mL, p < 0.001) and a trend toward higher CRP (8.1 vs 3.2 mg/L, p = 0.075). PD patients showed better dialysis adequacy (Kt/V 1.9 vs 1.6, p < 0.001) and a trend toward higher sural sensory conduction velocity (54 vs 48 m/s, p = 0.052). Axonal polyneuropathy predominated (37.5%), without difference between modalities. Median FFP score was 1 in both groups (p = 0.705), but frailty-category distribution differed (frail: HD 20.0% vs PD 6.9%, p = 0.047). Univariately, CRP correlated with frailty in HD (rs = 0.31, p = 0.038); age (rs = 0.34, p = 0.041), hemoglobin (rs = 0.39, p = 0.014) and Kt/V (rs = −0.37, p = 0.027) correlated in PD. In multivariable regression, CRP remained an independent correlate (B = 0.017, 95% CI 0.001–0.033, p = 0.042).Conclusion Although median FFP scores were similar, frailty distribution and its correlates differed by modality – inflammation in HD, age, and dialysis adequacy in PD. These hypothesis-generating findings warrant larger multicenter evaluation.