Prevalence of frailty in hemodialysis patients and its impact on long-term survival in elderly hemodialysis patients

Background The number of dialysis patients in China is rapidly increasing, with the proportion of older adults aged ≥ 60 years rising, linked to population aging and longer dialysis duration. This study investigated frailty prevalence in Chinese maintenance hemodialysis (MHD) patients, analyzed its status, risk factors and correlation with long-term survival in older dialysis patients to provide evidence for frailty interventions. Methods A total of 391 patients were assessed for frailty using the Frailty Screening Scale. Demographic, clinical, and biochemical data were collected, with 24-month follow-up for survival. Multivariate regression and Cox regression models were used for analyses. Results The cohort comprised 222 male patients (56.9%), with a mean age of 61 ± 13.9 years and a median dialysis vintage of 4 (2.0, 8.5) years. Patients aged ≥ 60 years accounted for 57.5% of participants. Frailty assessment showed that 85.3% of older patients had varying degrees of frailty, and 52.7% were in the pre-frail status. Increased age and low albumin level were identified as clinical correlates of frailty. During the 24-month follow-up period, a total of 88 deaths occurred. Regression analysis showed that patients under maintenance hemodialysis with frailty syndrome had a 3–5-fold higher mortality risk compared with non-frail individuals, and this association was more prominent in the elderly population aged over 60 years. Compared with patients with frailty syndrome, individuals in the pre-frail stage had markedly reduced mortality ( P = 0.009, P = 0.006). Conclusion Frailty is highly prevalent in older hemodialysis patients and closely correlated with increased mortality. Early frailty screening and risk stratification are essential for older dialysis patients and individuals at high risk of adverse clinical events. This study highlights the clinical value of early identification and standardized management of frailty, which can provide evidence for clinical diagnosis and treatment in this vulnerable population.