Comparison of diagnostic characteristics of four frailty screening tools in maintenance hemodialysis patients

The Fried Phenotype demonstrated the highest validity and diagnostic accuracy for frailty screening in MHD patients when benchmarked against a robust "leave-one-out" composite standard. The CFS also performed well with good agreement and discriminative ability. The FRAIL scale showed high sensitivity but lower specicity, while the T exhibited high specicity but poor sensitivity. Tool selection should be guided by clinical purpose-whether for screening, conrmation, or balanced assessment-to optimize frailty management in MHD patients and improve clinical outcomes.