Frailty Progression Tied to Sharp Rise in Mortality Risk Among Hemodialysis Patients: Study
China: A prospective cohort study published in BMC Nephrology has revealed that worsening frailty over time significantly increases the risk of death among patients receiving maintenance hemodialysis.
The study, led by Lan Liu from the Hebei Clinical Research Center for Chronic Kidney Disease in Shijiazhuang, China, highlights the prognostic importance of monitoring frailty transitions rather than relying on a single assessment.
Frailty—a condition marked by reduced physiological reserve and increased vulnerability to stressors—is frequently observed in individuals undergoing long-term hemodialysis. While previous research has established frailty as a predictor of poor outcomes, less is known about how changes in frailty status influence survival. To address this gap, the investigators examined whether progression or improvement in frailty over time affected all-cause mortality risk in patients on maintenance hemodialysis (MHD).
The study enrolled 313 patients with a median age of 60 years; 57.8% were men. Frailty was evaluated using the FRAIL scale at baseline and reassessed one year later. Based on these two evaluations, participants were categorized according to frailty transitions—such as remaining robust, worsening from robust to pre-frail or frail, progressing from pre-frail to frail, or improving to a less frail state. Patients were then followed for a median of 27 months, during which 51 deaths occurred.
The authors reported the following findings:
- Worsening frailty status was strongly associated with an increased risk of all-cause mortality.
- Patients who declined from robust to pre-frail or frail had more than a fourfold higher risk of death compared with those who remained robust (HR 4.24).
- Individuals who progressed from pre-frail to frail had an approximately eightfold higher mortality risk (HR 8.59).
- Improvement in frailty status was not associated with a significantly increased risk of death compared with stable, robust patients.
- Patients transitioning from pre-frail to robust or from frail to pre-frail/robust had mortality risks similar to consistently robust individuals.
- The association between frailty progression and mortality was consistent across age groups, sexes, and dialysis duration categories.
- Sensitivity analyses using competing risk models confirmed the stability of the findings.
The study highlights the importance of repeated frailty assessments in patients undergoing hemodialysis. Rather than viewing frailty as a static characteristic, clinicians may benefit from tracking changes over time to identify patients at escalating risk. The authors emphasize that preventing frailty progression—or promoting its reversal—should become a priority in future research and clinical practice, with the aim of improving survival outcomes in this vulnerable population.
Reference:
Liu, L., Jin, J., Zhang, D. et al. Changes in frailty and all-cause mortality in patients on hemodialysis: a prospective cohort study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04794-4
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