Clinical and Laboratory Parameters Predicting Frailty in End-Stage Kidney Disease Patients on Maintenance Dialysis

Background In the context of ESKD patients undergoing maintenance hemodialysis, frailty has emerged as a significant concern, with high prevalence ranging from 30% to >70%. In India, where the burden of CKD is increasing, understanding the prevalence and risk factors associated with frailty among hemodialysis patients is essential for developing targeted interventions. Materials and Methods This cross-sectional study screened 200 hemodialysis patients between June 2022 and December 2023; 170 met the eligibility criteria. Frailty was assessed using the Fried Frailty Phenotype and the Clinical Frailty Scale (CFS). For analysis, all patients were categorized into two categories - frail and non-frail. Demographic, clinical, and laboratory data were collected and compared. Results The study revealed a 49.4% frailty prevalence. Frail patients were predominantly female (79.1%) with a mean age of 42.3 years. Higher frailty rates were associated with diabetes (p=0.007), hypothyroidism (p<0.001), and coronary artery disease (p=0.004). Additional factors included longer dialysis vintage (p<0.001) and intra-dialytic hypotension (p=0.001). Nutritional indicators showed that frail patients had lower mid-upper arm circumference (MUAC) (p=0.05), albumin levels (p<0.001), and total cholesterol (p<0.004). Multivariate analysis identified independent predictors of frailty: female gender (OR=4.794), age over 37 years (OR=5.993), MUAC <22 cm (OR=4.238), serum albumin <4 g/dL (OR=5.11), total cholesterol <150 mg/dL (OR=2.758), intra-dialytic hypotension (OR=4.651), and hypothyroidism (OR=6.074). The CFS showed sensitivity of 52.38% and specificity of 94.19% compared to the Fried criteria. Conclusion Frailty is prevalent among hemodialysis patients and associates with other factors that are predictive of poor outcomes highlighting the need for routine assessments to identify at-risk individuals and implement effective interventions.