Changes in frailty and all-cause mortality in patients on hemodialysis: a prospective cohort study

Frailty is a common phenomenon among maintenance hemodialysis (MHD) patients. This prospective cohort study aimed to investigate the effect of changes in frailty status on the risk of all-cause mortality in MHD patients. Frailty transitions were assessed by frailty status at baseline and the second evaluation one year later according to the FRAIL scale. The primary outcome for this study was all-cause mortality. Kaplan–Meier analyses, Cox proportional hazard regression and trend test were used to identify the association between frailty status changes and all-cause mortality. A total of 313 patients were recruited, median age was 60.0 years, and 57.8% were males. Over a median follow-up of 27.0 months, there were 51 deaths. Multivariable regression analyses indicated that, compared with stable robust patients, those who progressed from robust to pre-frail/frail or from pre-frail to frail had a significantly increased risk of all-cause mortality(HRs of 4.24 [95% CI, 1.13–15.9] and 8.59 [95% CI, 2.26–32.7], respectively), whereas patients who improved from pre-frail to robust or from frail to pre-frail/robust had no significant difference in the risk of all-cause mortality (HRs of 0.70[95% CI, 0.08–6.38] and 0.57 [95% CI, 0.09–3.52], respectively). Subgroup analyses revealed that the effect of frailty transitions on all-cause death was consistent across different age, genders, and dialysis durations groups (P for interaction was 0.76, 0.399, and 0.178, respectively). Sensitivity analysis by competing risk models further confirmed the stability of these findings. Among MHD patients, the progression of frailty status has a notable link with an increased risk of all-cause mortality, while its improvement is associated with a risk comparable to that of stable robust patients. In the future, how to prevent the deterioration of frailty or improve the frailty status of MHD patients should become the focus of research.