Association between physical performance and cognitive frailty in middle-aged and older adults undergoing maintenance hemodialysis: a cross-sectional study

Cognitive frailty (CF), defined as the coexistence of physical frailty and cognitive impairment, may be reversible under certain conditions. Identifying factors associated with CF in patients undergoing maintenance hemodialysis (MHD) is important for early recognition and risk stratification. This cross-sectional study examined the association between physical performance and CF in 282 Chinese MHD patients aged ≥ 45 years. CF was assessed using standardized cognitive and frailty assessment tools, and physical performance was evaluated using handgrip strength (HGS), gait speed (GS), the Five Times Sit-to-Stand Test (STS5), and the Timed Up and Go Test (TUGT). Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. CF was identified in 44 participants (15.6%). Higher HGS (OR = 0.898, 95% CI: 0.835–0.965, P = 0.003) and faster GS (OR = 0.012, 95% CI: 0.001–0.253, P = 0.004) were independently associated with lower odds of CF, whereas longer STS5 completion time was associated with higher odds of CF (OR = 1.222, 95% CI: 1.096–1.363, P < 0.001). TUGT was not significantly associated with CF (OR = 1.125, 95% CI: 0.996–1.271, P = 0.057). All four physical performance indicators demonstrated high discriminatory performance for CF, with AUC values ranging from 0.921 to 0.931. In conclusion, three commonly used physical performance measures (HGS, GS, and STS5) were significantly associated with the presence of CF in Chinese MHD patients. These readily obtainable indicators may be useful for screening CF in clinical settings, supporting the role of physical performance assessment in this high-risk population.