Physical frailty and quality of life among elderly with renal failure at hemodialysis units in Wasit governorate, Iraq

Frailty is common among elderly individuals with chronic kidney disease, and substantial data endorsing the advantages of dialysis in this context is insufficient. This study aimed to assess the level of physical frailty and its association with health-related quality of life among elderly patients undergoing hemodialysis. A cross-sectional survey conducted among [ 1 ] hemodialysis patients in hemodialysis teaching hospitals in Al-Kut, Wasit, Iraq. Participants were recruited using a non-probability purposive sampling method from December, 2024 to July, 2025. The “World Health Organization Quality of Life Instruments” to determine the health-related quality of life and “Physical Frailty Phenotype Scale” to measure the level of frailty were used. A descriptive and inferential data analysis plus Pearson correlation test, t-test, one-way ANOVA, binary and multifactorial logistic regression were used to analyze data. The study indicates that elderly participants had high frailty prevalence, with more than three quarters of participants (77.5%) were classified as frail. Additionally, the psychological domain exhibited the highest quality of life score (53.5 ± 12.2), while the overall quality of life revealed the lowest score (42.0 ± 19.6), signifying a generally moderate impairment across the WHOQOL-BREF domains. The findings showed a strong negative correlation between physical frailty and quality of life ( r = − 0.742, p < 0.001). In turn, frailty was independently associated with longer duration of renal failure (β = 0.239, p = 0.003), lower number of dialysis per week (β = -0.224, p = 0.006), and lack of family support (β = -0.180, p = 0.021). Multiple linear regression identified family support (β = 0.240, p = 0.001), marital status (β = − 0.173, p = 0.014), occupation (β = − 0.184, p = 0.013), and body mass index (β = 0.157, p = 0.017) as significant independent predictors of quality of life. Finally, significant differences in frailty and quality of life were found for marital status, occupation, number of dialysisper week, and duration of renal failure. Physical frailty is highly prevalent among elderly patients undergoing hemodialysis and is strongly associated with poor health-related quality of life. These findings support the need for routine frailty assessment and targeted nursing interventions to improve hemodialysis patient outcomes.