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Predictors of Social Frailty and Depression in Brazilian Patients With Chronic Kidney Disease: A Cross-Sectional Study
Abstract:
BACKGROUND: Social frailty is linked to adverse health outcomes, including depression, especially in older and chronically ill individuals. This study aimed to assess the prevalence and associated factors of social frailty in Brazilian CKD patients undergoing hemodialysis or kidney transplantation and to examine its predictive role in the development of depressive symptoms.
METHODS: This cross-sectional, correlational, and comparative study included 284 patients with CKD from São Paulo, Brazil. Data were collected using validated instruments: HALFT Social Frailty Scale, Patient Health Questionnaire-9 (PHQ-9), and Medical Outcomes Study Social Support Scale (MOS). Two multiple linear regression (MLR) models were used to assess predictors of social frailty and depressive symptoms, adjusting for sociodemographic and clinical variables.
RESULTS: Social frailty was significantly more prevalent among HD patients (51.2%) compared to TX patients (24%). Social support was negatively associated with social frailty (β = -0.40; p < 0.001). Other predictors of greater social frailty included lower income (β = 0.51 for ≤ 1 minimum wage), number of medications (β = 0.11), and lower education (β = -0.13). In turn, social frailty was the strongest predictor of depressive symptoms (β = 0.60; p < 0.001). TX status and male sex were associated with lower depression scores.
CONCLUSION: Social frailty is highly prevalent in CKD patients, particularly those undergoing HD, and strongly predicts depressive symptoms. Strategies to enhance social support and reduce socioeconomic vulnerability may help mitigate mental health burdens in this population.
Source: Dos Santos Diana G Ms. Geriatrics & Gerontology International, Jan 2026; 26(1): e70317
Frailty in Focus: A Scoping Review of Frailty Instruments from the Kidney Disease Aging Research Collaborative
Abstract:
Source: Dos Santos Diana G Ms. Geriatrics & Gerontology International, Jan 2026; 26(1): e70317
Frailty in Focus: A Scoping Review of Frailty Instruments from the Kidney Disease Aging Research Collaborative
Abstract:
BACKGROUND: Frailty is a multi-system syndrome of decreased physiologic reserve with high prevalence, early incidence, and prognostic significance in kidney disease. Apart from the Physical Frailty Phenotype (PFP), less is known regarding psychometric properties of other instruments. We critically appraise the validity and reliability of frailty instruments across the kidney disease continuum, acknowledge limitations, and highlight knowledge gaps. METHODS: Following PRISMA-ScR guidelines, we searched PubMed, EMBASE, Cochrane, CINAHL, Web of Science, ClinicalTrials.gov, and PsycInfo from website inception through 9/2024. Eligible studies applied a validated frailty instrument apart from the PFP to a kidney disease population.
RESULTS: We identified 136 articles after screening 4,048 initial results. The most commonly cited instruments were the Clinical Frailty Scale (CFS; N=56), FRAIL Scale (N=30), and Edmonton Frail Scale (N=16). Most studies included adults receiving hemodialysis (N=85) and with chronic kidney disease (N=39). Median age ranges were 53–83 years. Most frailty instruments demonstrated predictive validity for mortality and hospitalizations. Concurrent validity was most frequently demonstrated between frailty and older age, female sex, greater comorbidities, and lower albumin. Seven studies reported reliability. While some instruments were feasible (CFS, FRAIL scale), their measurement could result in higher frailty prevalence compared to the PFP. Existing instruments do not capture the full spectrum of psychosocial and physiologic domains of frailty.
CONCLUSIONS: The CFS demonstrates the strongest validity, apart from the PFP, although its use may result in higher measured frailty prevalence. Further research should test the feasibility of screening for frailty in clinical practice; the psychometric properties (i.e., responsiveness) of frailty instruments in younger adults, those with acute kidney injury, kidney transplant recipients, and those receiving conservative kidney management; and whether adding psychosocial and/or physiological markers improves frailty measurement validity. Addressing these gaps will facilitate wider frailty measurement in kidney disease research and aid adoption into practice.
Source: Nair D. Clinical Journal of the American Society of Nephrology, Jan 2026;
Patient-reported outcome measures (proms) and frailty in kidney transplant candidates
Abstract:
Source: Nair D. Clinical Journal of the American Society of Nephrology, Jan 2026;
Patient-reported outcome measures (proms) and frailty in kidney transplant candidates
Abstract:
BACKGROUND AND OBJECTIVE: Patient-reported outcomes (PROMs) are key tools for advancing patient-centered clinical practice, with proven benefits for health outcomes. Their application has been extended to different chronic diseases, but there are few studies involving patients with chronic kidney disease (CKD), a population that is aging and frail. The aim of this study was to assess the relationship between frailty and self-reported health-related quality of life in patients with advanced CKD who are eligible for kidney transplantation (KT). MATERIALS AND METHODS: KT candidates who were evaluated in the outpatient clinic were included in the study. The PROMIS-29® and PROMIS-Global Health® questionnaires were administered, and T-scores were calculated for each domain. Frailty was assessed using the Fried scale, categorizing participants as frail/pre-frail if FRIED > 0. Sociodemographic and clinical variables were also collected.
RESULTS: 139 KT candidates were included in the study: 32% were women, the mean age was 63.5 years, 43.9% were on dialysis, and 64.5% were frail. 71.2% responded to the administered PROMIS. Overall, KT candidates reported their mental health as good (48 ± 7.4) and their physical health as fair (42.8 ± 7.3). T-scores for anxiety, fatigue, social functioning, sleep disturbance, pain, and depression were within the normal range compared to the general population. When comparing frail with robust patients, only the physical domain of PROMIS-Global Health® and physical function of PROMIS-29® were worse in the frail group. No differences were found in the other domains.
CONCLUSIONS: Frail kidney transplant candidates report worse physical function when assessed using PROMs tools. The systematic implementation of PROMs might help to implement strategies to optimize access to the waiting list, improve postKT outcomes, and enhance overall patient care.
Source: Redondo-Pachón D. Nefrologia, Jan 2026; 46(1): 501393
Risk Prediction Models for Frailty in Adult Maintenance Haemodialysis Patients: A Systematic Review and Methodological Appraisal
Abstract:
Source: Redondo-Pachón D. Nefrologia, Jan 2026; 46(1): 501393
Risk Prediction Models for Frailty in Adult Maintenance Haemodialysis Patients: A Systematic Review and Methodological Appraisal
Abstract:
BACKGROUND: Frailty affects over 35% of maintenance haemodialysis (MHD) patients globally-2-3 times higher than the general elderly-and is strongly linked to higher mortality, hospitalisation, and functional decline. Despite its clinical impact, frailty is often underdiagnosed in dialysis settings due to inconsistent assessments and limited resources. Existing prediction models vary widely in predictors and methods, requiring systematic review to guide clinical use and improve risk-stratified care.
AIM: To systematically identify, describe, and evaluate the existing risk prediction models for frailty in patients undergoing MHD.
DESIGN: Systematic review and Methodological appraisal.
DATA SOURCES: A comprehensive search was conducted across multiple databases-PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database-covering studies up to November 1, 2024.
REVIEW METHODS: Two researchers independently conducted literature searches, screening, and data extraction. They used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk of bias and the applicability of the included models. RESULTS: Fifteen studies (21 models) were analysed, with sample sizes 141-786 and frailty incidence 11.00%-59.57%. Model AUCs ranged 0.720-0.998 (potential overfitting at extreme values). Key predictors included age, serum albumin, gender, Charlson comorbidity index, and activities of daily living scores. Methodological appraisal using PROBAST revealed moderate applicability but high bias risks: 53% of studies used retrospective designs, 95% lacked external validation, and limitations included small samples, non-standard variable selection, and inadequate handling of missing data.
CONCLUSION: While models demonstrate initial predictive utility, widespread bias and developmental-stage limitations hinder clinical application. Future research must prioritise TRIPOD-guided model development, emphasising large prospective cohorts, rigorous validation, and transparent reporting to enhance reliability and clinical utility in frailty risk stratification for MHD patients.
Source: Zhang H. Journal of Advanced Nursing, Jan 2026; 82(1): 188-204
Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis
Abstract:
Source: Zhang H. Journal of Advanced Nursing, Jan 2026; 82(1): 188-204
Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis
Abstract:
BACKGROUND: The relationship between frailty/pre-frailty, and multimorbidity in the elderly is recognized, but specific prevalence among community-dwelling elderly with multimorbidity is unclear. This study aims to determine these rates, analyze subgroup, and identify sources of heterogeneity to bolster evidence-based interventions and health policies.
METHODS: We searched nine databases from inception to November 16, 2023, for cross-sectional and cohort studies on community-dwelling elderly with multimorbidity. Data were extracted to calculate the prevalence of frailty and pre-frailty. Study quality was assessed using AHRQ and NOS tools.
RESULTS: Fifteen studies encompassing 9,683 participants with multimorbidity were analyzed. The pooled prevalence of frailty and pre-frailty was 18.1 % and 48.9 %, respectively. Age-stratified analyses found 17 % frailty and 58.4 % pre-frailty in the 70-74 age group, and 16.7 % and 54.2 % in those above 75 years. Cross-sectional studies showed 18.8 % frailty and 48.1 % pre-frailty, while cohort studies showed 18.1 % and 50.5 %, respectively. Asia had higher rates (22.7 % frailty, 43.5 % pre-frailty) than the Americas (9.9 % frailty, 56.3 % pre-frailty). By sample size, frailty prevalence was 21.3 % (<500), 9.1 % (500-999), and 17.9 % (≥1000), with pre-frailty at 51.1 %, 45.6 %, and 47.7 %. The FP method yielded higher prevalence estimates (17.7 % frailty, 51.6 % pre-frailty) than the FS method (9.5 % frailty, 39.2 % pre-frailty).
CONCLUSION: This study provides insights into the prevalence of frailty and pre-frailty among community-dwelling elderly with multimorbidity. Variations in prevalence rates may be attributed to differences in sample size and measurement tools, which also contribute to heterogeneity observed across subgroups.
Source: Cai S. Archives of Gerontology and Geriatrics, May 2025; 132: 105782
Source: Cai S. Archives of Gerontology and Geriatrics, May 2025; 132: 105782
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A Mixed Methods Study of Risk Factors for Frailty in Peritoneal Dialysis Patients
Abstract:
A Mixed Methods Study of Risk Factors for Frailty in Peritoneal Dialysis Patients
Abstract:
OBJECTIVES: This study uses a convergent mixed methods approach to investigate the frailty phenotypes and risk factors in peritoneal dialysis (PD) patients. DESIGN: A cross-sectional mixed methods research study was employed.
METHODS: This study follows the MMR-RHS reporting guidelines. From November 2023 to August 2024, 213 patients were recruited from the PD centre of a tertiary hospital in Chongqing, China. Quantitative data were collected using a general information questionnaire and standardised scales, including Fried Frailty Phenotype (FFP), Charlson Comorbidity Index (CCI), Mini Nutritional Assessment-Short Form (MNA-SF), Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS). Concurrently, 19 PD patients in pre-frail or frail states participated in semi-structured interviews. The quantitative and qualitative findings were then integrated for analysis.
RESULTS: Amongst the 213 PD patients, 46.5% were non-frail, 41.3% were pre-frail and 12.2% were frail. Integrated analysis indicated that fatigue and low muscle strength were the primary frailty phenotypes amongst the patients. Age, sedentary behaviour, comorbidities, nutritional status, cognitive function, polypharmacy, psychological state and social connections were identified as risk factors for frailty in this patient population.
CONCLUSION: Many factors influence the frailty of PD patients. Future research should further explore the complex interactions amongst these factors and effective modulation strategies to mitigate the frailty progression. Incorporating the patients' perspectives in designing comprehensive intervention programmes will help identify key challenges and focal points for intervention.
IMPACT: This study identifies risk factors for frailty in PD patients, offering healthcare professionals a basis for designing targeted interventions. These factors encompass multiple dimensions, indicating the need for multidisciplinary collaboration in managing frailty.
PATIENT CONTRIBUTION: The PD patients in this study provided valuable quantitative data and shared their frailty experiences, enhancing the research conclusions' practical value.
Source: Cao W. Journal of Clinical Nursing, Sep 2025; 34(9): 3604-3619
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of model performance and methodological quality
Abstract:
Source: Cao W. Journal of Clinical Nursing, Sep 2025; 34(9): 3604-3619
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of model performance and methodological quality
Abstract:
BACKGROUND: Frailty affects outcomes in maintenance hemodialysis (MHD) patients, highlighting the need for reliable predictive tools. Despite the rise of predictive models, the clinical validity and scientific quality of these models remain unknown.
OBJECTIVE: The purpose of this systematic review is to assess the clinical usefulness, predictive accuracy, and methodological quality of the current frailty risk prediction models in patients with MHD.
METHODS: Databases including PubMed, Embase, Cochrane Library, CNKI, and others were comprehensively searched until August 2024. Studies that created or validated frailty risk prediction models for adult MHD patients were considered. The Newcastle-Ottawa Scale (NOS) and PROBAST were used to measure quality. The meta-analysis examined common predictive factors.
RESULTS: Twelve of the 824 papers that reported 14 prediction models satisfied the inclusion criteria. The most common method was logistic regression. Frailty prevalence ranged from 17.2% to 79.2%. Age, albumin, depression, and dietary condition were among the variables that were most often found. Model performance varied considerably, with area under the curve (AUC) ranging from 0.72 to 0.998. All studies had significant methodological deficiencies. CONCLUSIONS: Existing frailty risk prediction models demonstrate potential utility but currently suffer from significant methodological flaws and limited external validation, impairing their clinical applicability. Future models should emphasize rigorous study design, standardized statistical methods, and robust external validation. Clinicians should cautiously interpret existing models while focusing on critical predictors such as age, albumin, depression, and nutrition for frailty management in MHD patients.
Source: Chen Z. Renal Failure, Dec 2025; 47(1): 2522329
Effects of Exercise on Sarcopenia and Frailty in Haemodialysis Patients: A Systematic Review
Source: Chen Z. Renal Failure, Dec 2025; 47(1): 2522329
Effects of Exercise on Sarcopenia and Frailty in Haemodialysis Patients: A Systematic Review
Abstract:
Background and Objectives: Chronic kidney disease is characterized by the progressive loss of functioning nephrons due to structural and functional alterations in the kidneys. It is clinically defined through the presence of a glomerular filtration rate below 60 mL/min/1.73 m(2) or persistent kidney damage lasting at least three months. Patients undergoing haemodialysis frequently present with sarcopenia and frailty. The aim of this study was to evaluate the effects of intradialytic exercise on sarcopenia and frailty in individuals with chronic kidney disease. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. Electronic searches were executed in PubMed, PEDro, Scopus, and Dialnet. Eligible studies included adults (≥18 years) on haemodialysis who engaged in exercise interventions compared with passive control groups. Exclusion criteria included any conditions conflicting with the inclusion criteria, systematic reviews, study protocols, and articles not meeting the PICO framework or contradictory to the inclusion criteria. Outcomes of interest were sarcopenia and frailty, assessed through measures of physical function and muscle strength. Methodological quality was appraised using the PEDro scale, and risk of bias was evaluated with the Cochrane Risk of Bias tool.
Results: Fifteen studies met the inclusion criteria. Most interventions consisted of aerobic training, resistance training, or combined exercise programs. Across studies, exercise interventions consistently improved physical function and muscle strength, although no significant effects on body composition were observed.
Conclusions: This systematic review provides evidence that intradialytic exercise may produce clinically relevant improvements in sarcopenia by enhancing muscle strength and functional performance, as measured by tests such as the sitting-to-standing test. These results suggest that intradialytic exercise could be beneficial for patients with chronic kidney disease.
Source: Garrido-Ardila Elisa M. Medicina (Kaunas, Lithuania), Dec 2025; 61(12): 2204
Comparison of diagnostic characteristics of four frailty screening tools in maintenance hemodialysis patients
Abstract:
Source: Garrido-Ardila Elisa M. Medicina (Kaunas, Lithuania), Dec 2025; 61(12): 2204
Comparison of diagnostic characteristics of four frailty screening tools in maintenance hemodialysis patients
Abstract:
BACKGROUND: A variety of frailty assessment tools are used internationally, and there is variation in the selection of frailty assessment tools for patients undergoing maintenance hemodialysis (MHD). The most suitable tool for this population remains unclear. This study compared the validity of four frailty assessment tools-the Fried Phenotype, FRAIL Scale, Clinical Frailty Scale (CFS), and Tilburg Frailty Index (T)-among MHD patients. The aim is to provide a reference for healthcare professionals selecting appropriate tools.
METHODS: A convenience sample of 385 patients undergoing maintenance hemodialysis at two hemodialysis centers in Sichuan, China, from January to June 2025 was selected as the study population. All patients were assessed for frailty severity using four instruments. To minimize inclusion bias, the "leave-one-out" composite index (CI) was employed as the reference standard. Kappa statistics and McNemar's test were used to evaluate agreement between each tool and its corresponding CI. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Decision curve analysis (DCA) evaluated clinical utility.
RESULTS: The Fried Phenotype demonstrated the strongest agreement with its CI (Kappa = 0.789, P < 0.001), indicating excellent concordance and no signicant marginal heterogeneity (McNemar's P = 1.000). The CFS also showed good agreement with its CI (Kappa = 0.716, P < 0.001) without signicant marginal heterogeneity (McNemar's P = 0.074). In contrast, while the FRAIL and T showed moderate agreement with their respective CIs (Kappa = 0.705 and 0.537; both P < 0.001), McNemar's test indicated signicant marginal heterogeneity for both (P < 0.001). The AUC was highest for the Fried Phenotype (0.90), followed by CFS (0.85), T (0.84), and FRAIL (0.82). The Fried Phenotype achieved the best balance between sensitivity (93%) and specicity (86%). Decision curve analysis conrmed its superior net benet across most clinical threshold probabilities.
CONCLUSION: 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.
Source: Guo, Xuemei. International Urology and Nephrology, Oct 2025;
Cognitive Frailty and Its Risk Factors Among Patients With Chronic Kidney Disease Receiving Hemodialysis: A Cross-Sectional Study
Abstract: Cognitive frailty can lead to an impaired functional capacity and a poor quality of life, especially in patients on hemodialysis. This study aimed to investigate cognitive frailty and its risk factors in patients with chronic kidney disease (CKD) receiving hemodialysis. A cross-sectional study was conducted between April and June 2021 involving 220 patients with CKD receiving hemodialysis at a hospital-based hemodialysis center in northern Taiwan. Data were collected using a structured survey covering demographics, cognitive function, physical frailty, depressive symptoms, physical activity, and nutritional status. Univariate and multivariate logistic regression models were used to identify risk factors for cognitive frailty. In total, 220 patients were recruited. Prevalences of cognitive impairment, physical frailty, depressive symptoms, and cognitive frailty were 46.8%, 10.0%, 52.3%, and 9%, respectively. Univariate and multivariate logistic regression analyses, adjusted for age, sex, and years of hemodialysis, identified malnutrition (aOR = 12.405; 95% CI = 3.29-46.81) and physical inactivity (aOR = 89.445; 95% CI = 5.87-1363.93) as significant risk factors for cognitive frailty. The study suggests the need for strategies to enhance physical activity and nutritional status to prevent cognitive frailty in patients with CKD receiving hemodialysis.
Source: Ho M. Nursing and Health Sciences, Sep 2025; 27(3): e70197
Multidimensional Determinants of Frailty in Haemodialysis Patients: The Overlooked Roles of Depression and Cognitive Function
Abstract:
Source: Guo, Xuemei. International Urology and Nephrology, Oct 2025;
Cognitive Frailty and Its Risk Factors Among Patients With Chronic Kidney Disease Receiving Hemodialysis: A Cross-Sectional Study
Abstract: Cognitive frailty can lead to an impaired functional capacity and a poor quality of life, especially in patients on hemodialysis. This study aimed to investigate cognitive frailty and its risk factors in patients with chronic kidney disease (CKD) receiving hemodialysis. A cross-sectional study was conducted between April and June 2021 involving 220 patients with CKD receiving hemodialysis at a hospital-based hemodialysis center in northern Taiwan. Data were collected using a structured survey covering demographics, cognitive function, physical frailty, depressive symptoms, physical activity, and nutritional status. Univariate and multivariate logistic regression models were used to identify risk factors for cognitive frailty. In total, 220 patients were recruited. Prevalences of cognitive impairment, physical frailty, depressive symptoms, and cognitive frailty were 46.8%, 10.0%, 52.3%, and 9%, respectively. Univariate and multivariate logistic regression analyses, adjusted for age, sex, and years of hemodialysis, identified malnutrition (aOR = 12.405; 95% CI = 3.29-46.81) and physical inactivity (aOR = 89.445; 95% CI = 5.87-1363.93) as significant risk factors for cognitive frailty. The study suggests the need for strategies to enhance physical activity and nutritional status to prevent cognitive frailty in patients with CKD receiving hemodialysis.
Source: Ho M. Nursing and Health Sciences, Sep 2025; 27(3): e70197
Multidimensional Determinants of Frailty in Haemodialysis Patients: The Overlooked Roles of Depression and Cognitive Function
Abstract:
AIM: This study aims to examine the level of frailty in patients undergoing haemodialysis treatment and investigate the effects of sociodemographic, psychological and clinical variables on frailty.
METHOD: A cross-sectional and correlational research design was employed with 386 haemodialysis patients over the age of 50. Data were collected using the Edmonton Frail Scale, Beck Depression Inventory, Standardized Mini-Mental Test and Eysenck Personality Questionnaire.
RESULTS: The study revealed that 48.4% of haemodialysis patients fell into the 'apparently frail' category, and frailty levels were significantly associated with age, depression and cognitive functions (p < 0.05). However, no significant effect of gender, marital status, educational level, chronic diseases or personality traits on frailty was identified. CONCLUSIONS: Most haemodialysis patients were found to be apparently frail, with frailty levels increasing with age. Furthermore, frailty was linked to higher levels of depressive symptoms and lower cognitive function. Evaluating depression and cognitive function is crucial for alleviating frailty symptoms and improving quality of life.
Source: İncazlı Seçil B. International Journal of Nursing Practice, Oct 2025; 31(5): e70042
Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
Source: İncazlı Seçil B. International Journal of Nursing Practice, Oct 2025; 31(5): e70042
Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
AIMS: To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD).
DESIGN: A cross-sectional study.
METHODS: From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels.
RESULTS: Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty.
CONCLUSION: Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty. REPORTING METHOD: The study adhered to the STROBE checklist.
IMPACT: Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD.
PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Source: Li S. Journal of Clinical Nursing, Sep 2025; 34(9): 3693-3703
Frailty and Outcomes in Elderly ICU Patients: Insights from a Portuguese Cohort
Abstract:
Source: Li S. Journal of Clinical Nursing, Sep 2025; 34(9): 3693-3703
Frailty and Outcomes in Elderly ICU Patients: Insights from a Portuguese Cohort
Abstract:
Background: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting.
Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes.
Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall.
Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making.
Source: Lourenço E. Healthcare (Basel, Switzerland), Nov 2025; 13(23): 3063
Falls, Frailty and Quality of Life Among Individuals on a Regular Haemodialysis Programme: Implications for Rehabilitation Nursing
Abstract:
Source: Lourenço E. Healthcare (Basel, Switzerland), Nov 2025; 13(23): 3063
Falls, Frailty and Quality of Life Among Individuals on a Regular Haemodialysis Programme: Implications for Rehabilitation Nursing
Abstract:
BACKGROUND: Chronic kidney disease and haemodialysis treatment are associated with physiological and functional alterations that compromise postural stability, favouring frailty and the risk of falls. These conditions directly affect the quality of life and autonomy of people undergoing haemodialysis, constituting an important challenge for rehabilitation nursing. In this sense, the aim of this study was to analyse the relationship between falls, frailty and quality of life in people with chronic kidney disease on a regular haemodialysis programme, identifying implications for rehabilitation nursing care.
METHODS: This was a quantitative, observational and cross-sectional study conducted with 62 participants from a haemodialysis unit in northern Portugal. The Tilburg Frailty Indicator and the Kidney Disease Quality of Life Instrument (KDQOL-SF™ 1.3) were applied. Statistical analysis used parametric and non-parametric tests, considering a significance level of p < 0.05.
RESULTS: The prevalence of falls in the year preceding the data collection was 32.2%, and the prevalence of frailty was 40.3%. A significant association was found between frailty and falls (p = 0.038) and between sex and falls (p = 0.002). The dimensions Symptoms/problems and Effects of kidney disease on daily life showed lower scores among participants with falls (p < 0.001).
CONCLUSIONS: Frailty and poorer illness perception were associated with the occurrence of falls and with lower quality of life. Comprehensive assessment and the implementation of rehabilitation programmes led by specialist nurses in rehabilitation nursing are essential to promote functionality, safety and autonomy in people undergoing haemodialysis.
Source: Martins Marisa P. International Journal of Environmental Research and Public Health, Dec 2025; 23(1): 15
The Effect of Frailty on Quality of Life in Older Patients Receiving Hemodialysis and Associations With Fear of Falling
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Source: Martins Marisa P. International Journal of Environmental Research and Public Health, Dec 2025; 23(1): 15
The Effect of Frailty on Quality of Life in Older Patients Receiving Hemodialysis and Associations With Fear of Falling
Abstract:
PURPOSE: This study investigated the effect of frailty and avoidance behavior due to fear of falling on the quality of life in older patients receiving hemodialysis treatment.
METHODS: This study is cross-sectional and descriptive. The study was conducted between January 2 and 31, 2022, with 154 individuals aged 65 years and over receiving treatment in dialysis centers. The study data were collected using the Patient Information Form, Edmonton Frail Scale, Fear of Falling Avoidance-Behavior Questionnaire, and Quality of Life Scale (SF-12).
RESULTS: The Mean Edmonton Frail Scale score was found to be 8.7 ± 3.36, the mean Fear of Falling Avoidance-Behavior Questionnaire score was found to be 33.17 ± 9.11, the mean SF-12 physical component score was found to be 34.32 ± 8.51, and the mean mental component score was seen as 41.77 ± 8.35. The Fear of Falling Avoidance-Behavior Questionnaire was an associated factor in the effect of the Edmonton Frail Scale on quality of life. It strengthened the negative impact of the Edmonton Frail Scale on quality of life. The predictive effect of these two variables in explaining quality of life was 59.3%.
CONCLUSION: It was found that the participants had moderate levels of frailty, moderate levels of activity limitation, and participation restriction due to fear of falling, and low levels of physical and mental quality of life. It was determined that frailty had a direct impact on quality of life. Also, the indirect effect of frailty on quality of life was determined through the role of avoidance behavior due to fear of falling.
Source: Özer Z. Hemodialysis International. International Symposium on Home Hemodialysis, Jul 2025; 29(3): 371-380
Renal frailty
Abstract: Renal Frailty is a quality improvement project to improve the experiences and outcomes for frail or older patients with advanced kidney disease by integrating assessment and support into routine care.
Information for patients and carers about being an older person with kidney failure.
Source: Prima G. Imperial College Healthcare NHS Trust, Sep 2025
Quality of life experience in physically frail people on renal dialysis: A qualitative meta-synthesis on the difficulties and resources for better health care
Abstract:
Source: Özer Z. Hemodialysis International. International Symposium on Home Hemodialysis, Jul 2025; 29(3): 371-380
Renal frailty
Abstract: Renal Frailty is a quality improvement project to improve the experiences and outcomes for frail or older patients with advanced kidney disease by integrating assessment and support into routine care.
Information for patients and carers about being an older person with kidney failure.
Source: Prima G. Imperial College Healthcare NHS Trust, Sep 2025
Quality of life experience in physically frail people on renal dialysis: A qualitative meta-synthesis on the difficulties and resources for better health care
Abstract:
OBJECTIVE: This study aimed to summarize the quality of life experiences of individuals with physical frailty undergoing hemodialysis or peritoneal dialysis and to identify the difficulties and resources that enable better person-centered health care.
METHODS: The study described is a qualitative meta-synthesis literature review. The search was performed in databases such as CINAHL, Scopus, PubMed, Web of Science, the Cochrane Library, and Cuiden Plus through Medical Subject Headings and free terms. Qualitative and mixed studies were included on individuals undergoing hemodialysis or peritoneal dialysis, 18 years of age or older, published in English or Spanish, between January 2013 and January 2024. The Mixed Methods Appraisal Tool was used to assess the methodological quality. The information was analyzed and coded through a socioecological model and the social determinants of health.
RESULTS: Fourteen qualitative and two mixed articles were selected. A total of 256 individuals participated in the study. Seventeen themes and 25 sub-themes were identified and grouped into two blocks (difficulties and resources). The difficulties that stood out were a low tolerance for activities of daily living and physical activity, loss of self-control over life and social roles, and lack of community and public resources. As for the resources, the following was found: the positive meaning of dialysis, the safety offered by close individuals and the healthcare team, the activation of specific programs, and person-centered policies.
CONCLUSIONS: The analysis and interpretation of the identified difficulties and resources revealed key elements to consider when designing and implementing health programs for individuals undergoing dialysis. Future research should explore these dimensions in diverse cultural and geographical contexts to enhance generalizability and support health equity.
Source: Ramírez-García A. International Journal of Nursing Sciences, Jun 2025; 12(4): 344-351
Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis
Abstract:
Source: Ramírez-García A. International Journal of Nursing Sciences, Jun 2025; 12(4): 344-351
Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis
Abstract:
OBJECTIVES: This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence.
METHODS: A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis.
RESULTS: A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels.
CONCLUSIONS: This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis.
REGISTRATION NUMBER: PROSPERO CRD42024525375.
Source: Tang J. Renal Failure, Dec 2025; 47(1): 2485375
A qualitative study describing the perspectives on frailty and its management in individuals with kidney failure
Abstract:
Source: Tang J. Renal Failure, Dec 2025; 47(1): 2485375
A qualitative study describing the perspectives on frailty and its management in individuals with kidney failure
Abstract:
Key Points:
Methods: We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021 to June 2023. We conducted focus groups and semistructured interviews with patients (50 years or older with dialysis-dependent or nondependent kidney failure), caregivers, allied health care professionals, and nephrologists. We used qualitative description and inductive thematic analysis to describe their perspectives.
Results: Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied health care professionals (N=38), and nephrologists (N=14). We identified three themes, each with subthemes: (1) What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed; (2) discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss; (3) frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation.
Conclusions: Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.
- The term, frailty, had unclear meaning for most participants but was commonly explained as weakness, dependence, and unmodifiable.
- Knowledge of frailty assessment tools and the evidence to support their prognostic utility was low among clinicians.
- Though patients and caregivers saw value in discussing frailty, the label of frailty was often viewed as pejorative.
Methods: We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021 to June 2023. We conducted focus groups and semistructured interviews with patients (50 years or older with dialysis-dependent or nondependent kidney failure), caregivers, allied health care professionals, and nephrologists. We used qualitative description and inductive thematic analysis to describe their perspectives.
Results: Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied health care professionals (N=38), and nephrologists (N=14). We identified three themes, each with subthemes: (1) What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed; (2) discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss; (3) frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation.
Conclusions: Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.
Source: Thompson S. Clinical Journal of the American Society of Nephrology, 2025; 10.2215
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The Relationship Between Xerostomia, Nutrition, and Frailty in Older Patients Undergoing Hemodialysis
Abstract: Older adults receiving hemodialysis are at increased risk for xerostomia, poor nutritional status, and frailty, all of which significantly impact clinical outcomes and quality of life. This cross-sectional study examined interrelationships among xerostomia, nutrition, and frailty in patients aged 60 and older undergoing maintenance hemodialysis. Conducted between October 2022 and June 2023 in five dialysis centers, the study included 176 participants on hemodialysis for at least 3 months. Data were collected through face-to-face interviews using validated instruments: the Short Xerostomia Inventory, Mini Nutritional Assessment-Short Form, and Edmonton Frailty Scale. Pearson's correlation and path analysis using the Maximum Likelihood method were employed. Although xerostomia was reported at a low rate, many patients were at risk of malnutrition and showed varying degrees of frailty. Xerostomia was negatively associated with nutritional status and positively with frailty, while better nutritional status was linked to lower frailty. Path analysis revealed that xerostomia and nutritional status together explained nearly 50% of frailty variance. These findings underscore the importance of early identification and multidisciplinary management to reduce frailty and improve outcomes in older adults undergoing hemodialysis.
Source: Uslu A. Nursing and Health Sciences, Sep 2025; 27(3): e70203
Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
The Relationship Between Xerostomia, Nutrition, and Frailty in Older Patients Undergoing Hemodialysis
Abstract: Older adults receiving hemodialysis are at increased risk for xerostomia, poor nutritional status, and frailty, all of which significantly impact clinical outcomes and quality of life. This cross-sectional study examined interrelationships among xerostomia, nutrition, and frailty in patients aged 60 and older undergoing maintenance hemodialysis. Conducted between October 2022 and June 2023 in five dialysis centers, the study included 176 participants on hemodialysis for at least 3 months. Data were collected through face-to-face interviews using validated instruments: the Short Xerostomia Inventory, Mini Nutritional Assessment-Short Form, and Edmonton Frailty Scale. Pearson's correlation and path analysis using the Maximum Likelihood method were employed. Although xerostomia was reported at a low rate, many patients were at risk of malnutrition and showed varying degrees of frailty. Xerostomia was negatively associated with nutritional status and positively with frailty, while better nutritional status was linked to lower frailty. Path analysis revealed that xerostomia and nutritional status together explained nearly 50% of frailty variance. These findings underscore the importance of early identification and multidisciplinary management to reduce frailty and improve outcomes in older adults undergoing hemodialysis.
Source: Uslu A. Nursing and Health Sciences, Sep 2025; 27(3): e70203
Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
OBJECTIVE: Chronic kidney disease (CKD) has become a major challenge in global public health, and China has one of the heaviest burdens of CKD in the world, approximately 89.5% of patients require hemodialysis. Cognitive frailty (CF) is a condition characterized by physical frailty and cognitive impairment while excluding Alzheimer's disease and other dementias. CF is associated with adverse clinical outcomes, including hospitalization, disability, and increased mortality. The purpose of this study was to explore the prevalence and influencing factors of CF in Chinese maintenance hemodialysis (MHD) patients through systematic review and meta-analysis.
METHODS: We searched PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP) and Chinese Biomedical Database (CBM) for epidemiological data on CF in Chinese patients undergoing MHD from inception to December 2024. A random-effects model was used to estimate the overall prevalence of CF in Chinese patients undergoing MHD. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate factors associated with CF in Chinese patients undergoing MHD. Stata 15.0 software was used to conduct systematic review and meta-analysis of the prevalence and influencing factors of CF in Chinese patients undergoing MHD.
RESULTS: A total of 16 studies with 5690 Chinese patients undergoing MHD were included. The results of this meta-analysis showed that the prevalence of CF in Chinese patients undergoing MHD was 25%. The results of subgroup analyses showed that the frailty assessment tool (TFI) and education level (≥ College) may be sources of heterogeneity in the prevalence of CF in Chinese patients undergoing MHD. The meta-analysis results indicate that age (> 60, > 75), female, depression (HADS scale), malnutrition, triglycerides, waist circumference, stroke history, fall history, complications, CCI, comorbidities and dialysis age were risk factors for CF. High education level, calf circumference and serum creatinine level were protective factors for CF.
CONCLUSIONS: The prevalence of CF in Chinese patients undergoing MHD is high (25%). Therefore, this patient population necessitates early screening and targeted interventions with influencing factors.
PROSPERO REGISTRATION NUMBER FOR THIS STUDY: CRD42023493122CRD42023475424.
Source: Wei, X. BMC Nephrology, Jul 2025; 26(1): 365-9
Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients
Abstract: This review evaluates the effectiveness of nutritional supplementation combined with exercise training on frailty characteristics, physical function, and health-related quality of life in patients with chronic kidney disease (CKD). A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted, identifying 7 articles (9 trials, 324 patients). Meta-analysis showed that combined interventions improved frailty characteristics, such as walking speed (mean difference: 0.09 m/s, 95% confidence interval (CI): 0.02 to 0.16) and physical functioning, including cardiorespiratory fitness (standardized mean difference: 0.56, 95% CI: 0.20 to 0.93) and lower extremity mobility (Timed Up and Go test: -1.11 s, 95% CI: -1.79 to -0.43). However, effects on body weight, fatigue, and health-related quality of life remain uncertain. Due to study heterogeneity and small sample sizes, findings should be interpreted cautiously. Larger, long-term studies are needed to confirm these results and explore additional health outcomes.
Source: Zhang F. Journal of Renal Nutrition, Mar 2025; 35(2): 259-270
Cognitive frailty in maintenance hemodialysis: a scoping review
Abstract:
Source: Wei, X. BMC Nephrology, Jul 2025; 26(1): 365-9
Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients
Abstract: This review evaluates the effectiveness of nutritional supplementation combined with exercise training on frailty characteristics, physical function, and health-related quality of life in patients with chronic kidney disease (CKD). A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted, identifying 7 articles (9 trials, 324 patients). Meta-analysis showed that combined interventions improved frailty characteristics, such as walking speed (mean difference: 0.09 m/s, 95% confidence interval (CI): 0.02 to 0.16) and physical functioning, including cardiorespiratory fitness (standardized mean difference: 0.56, 95% CI: 0.20 to 0.93) and lower extremity mobility (Timed Up and Go test: -1.11 s, 95% CI: -1.79 to -0.43). However, effects on body weight, fatigue, and health-related quality of life remain uncertain. Due to study heterogeneity and small sample sizes, findings should be interpreted cautiously. Larger, long-term studies are needed to confirm these results and explore additional health outcomes.
Source: Zhang F. Journal of Renal Nutrition, Mar 2025; 35(2): 259-270
Cognitive frailty in maintenance hemodialysis: a scoping review
Abstract:
PURPOSE: To conduct a scoping review of the related research on cognitive frailty (CF) in maintenance hemodialysis (MHD) patients, so as to provide a basis for early diagnosis, treatment and intervention of CF in MHD patients.
METHODS: Utilizing a scoping review approach, we searched PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, the China Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu (VIP) for literature on CF in MHD patients up to October 20, 2024. Two researchers conducted independent screening and data extraction of the literature's fundamental characteristics. The study is registered in OSF (https://doi.org/10.17605/OSF.IO/H6Q89).
RESULTS: The review included 21 articles, revealing a concerningly high prevalence of CF in MHD patients, ranging from 4.6 to 56.4%. Six diagnostic combinations were identified, with the combination of Frailty Phenotype (FP), Montreal Cognitive Assessment (MOCA), and Clinical Dementia Rating (CDR) scales being the most prevalent. Influencing factors were categorized into demographic and lifestyle, physical condition, disease-related and psychosocial aspects. Interventions included exercise, cognitive therapy combined with exercise, social support and predictive nursing, yet there remains a scarcity of intervention studies.
CONCLUSION: The prevalence of CF in MHD patients is high; however, understanding of CF in MHD patients is insufficient. There are many types of assessment tools, but there is a lack of unified standards and specificity; the influencing factors are complex and diverse; and prevention and intervention studies are scarce.
Source: Zhang K. International Urology and Nephrology, Jul 2025; 57(7): 2159-2169
Source: Zhang K. International Urology and Nephrology, Jul 2025; 57(7): 2159-2169
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Prevalence and Associated Factors of Social Frailty in Older Patients on Maintenance Hemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
Prevalence and Associated Factors of Social Frailty in Older Patients on Maintenance Hemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
INTRODUCTION: Given that social frailty is closely associated with adverse health outcomes among older maintenance hemodialysis (MHD) patients, this study aimed to investigate the prevalence of social frailty among older MHD patients, with an emphasis on its correlation with factors such as family functioning, self-care ability, depression, and physical frailty. METHODS: A multi-center cross-sectional investigation was conducted to recruit older patients with MHD between September and December 2024 from four hemodialysis centers in four tertiary hospitals in Sichuan Province, China. Self-report scales were employed to collect general information and assess the participants' social frailty, family functioning, depression, and physical frailty. Univariate analysis and binary logistic regression analysis were adopted to determine the predictors of social frailty.
RESULTS: A total of 386 older MHD patients were included in the analysis. Of the participants, 205 (53.1%) were diagnosed with social frailty. Binary logistic regression analyses demonstrated that family functioning (OR = 0.863, 95% CI: 0.776-0.960, p = 0.007), self-care ability (OR = 3.527, 95% CI: 1.958-6.352, p < 0.001), depression (OR = 2.007, 95% CI: 1.180-3.415, p = 0.010), and physical frailty (OR = 2.261, 95% CI: 1.237-4.133, p = 0.008) were significantly associated with social frailty among older MHD patients.
CONCLUSIONS: Social frailty is highly prevalent among older patients with MHD. In addition, family function, self-care ability, depression, and physical frailty were detected to be independently associated with social frailty. These findings could facilitate the refinement of daily care strategies for older patients with MHD to reduce or mitigate the negative effects of social frailty.
Source: Zhang Q. Therapeutic Apheresis and Dialysis, Dec 2025; 29(6): 878-884
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China
Abstract:
Source: Zhang Q. Therapeutic Apheresis and Dialysis, Dec 2025; 29(6): 878-884
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China
Abstract:
OBJECTIVES: To systematically evaluate and meta-analyze the performance, validity, and influencing factors of frailty risk prediction models specifically developed for patients undergoing maintenance hemodialysis in China.
METHODS: China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were searched from inception to October 10, 2024. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the incidence rates and identify independent predictors.
RESULTS: Fourteen studies incorporating 16 distinct frailty risk prediction models were included. The predictive accuracy, measured by the area under the receiver operating characteristic curve (AUC), ranged from 0.819 to 0.998. Seven studies performed internal validation, one study executed external validation, and one study conducted both internal and external validation. All studies exhibited a high overall risk of bias. Pooled incidence of frailty among maintenance hemodialysis patients was 32.2% (95% CI: 26.9%-37.6%). Significant predictors of frailty included advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression (p < 0.05).
CONCLUSIONS: The pooled incidence of frailty among maintenance hemodialysis patients was notably high at 32.2%, with advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression emerging as significant predictors. Existing frailty prediction models for maintenance hemodialysis patients demonstrated robust predictive capacity but exhibited substantial methodological limitations, high bias and limited external validation. Future research should prioritize multicenter, large sample, validation studies to enhance applicability and reliability.
Source: Zhang Z. Renal Failure, Dec 2025; 47(1): 2500663
Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients
Abstract:
Source: Zhang Z. Renal Failure, Dec 2025; 47(1): 2500663
Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients
Abstract:
OBJECTIVE: To construct and evaluate a novel nomogram for predicting the risk of dual dimensional frailty (comorbidity between physical frailty and social frailty) in older maintenance haemodialysis.
METHODS: A cross-sectional investigation was conducted. A total of 386 older MHD patients were recruited between September and December 2024 from four haemodialysis centres in four tertiary hospitals in Sichuan Province, China. LASSO regression and binary logistic regression were employed to determine the predictors of dual dimensional frailty. The prediction performance of the model was evaluated by discrimination and calibration. The decision curve was utilised to estimate the clinical utility. Internal validation with 1000 bootstrap samples was conducted to minimise overfitting.
RESULTS: In the overall sample (386 cases), a total of 92 (23.8%) of patients exhibited dual dimensional frailty. Five relevant predictors, including physical activity, self-perceived health status, ADL impairment, malnutrition, and self-perceptions of aging, were identified for constructing the nomogram. Internal validation indicated excellent discriminatory power and calibration of the model, while the clinical decision curve demonstrated its remarkable clinical utility.
CONCLUSIONS: The novel nomogram constructed in this study holds promise for aiding healthcare professionals in identifying physical and social frailty risks among older patients on maintenance haemodialysis, potentially informing early and targeted interventions. RELEVANCE TO CLINICAL PRACTICE: This nomogram enables nurses to efficiently stratify dual-dimensional frailty risk during routine assessments, facilitating early identification of high-risk patients. Its visual output can guide tailored interventions, such as exercise programmes, nutritional support, and counselling, while optimising resource allocation.
PATIENT OR PUBLIC CONTRIBUTION: Data were collected from self-reported conditions and patients' clinical information.
REPORTING METHOD: STROBE checklist was employed.
Source: Zhou X. Journal of Clinical Nursing, Dec 2025; 34(12): 5315-5327
Utilizing Frailty Assessment to Impact Nursing Care for Patients with End Stage Kidney Disease: A Quality Improvement Project
Abstract: Frailty is highly prevalent in patients with end stage kidney disease (ESKD) and predictive of morbidity. Nurses lack frailty education and face practical challenges to assessment, which prevent effective interventions to address frailty. A quality improvement project sought to determine if frailty education and utilization of a renal frailty index tool impacts telephonic case management nursing care of patients by improving knowledge, perception, identification, and assessment of frailty, thereby prompting nursing interventions. Positive impacts were seen across all outcomes influencing outreach and resource utilization by nurses. Limitations included a small sample size, time burden, and manual processes. Findings suggest the importance of embedding frailty care into daily practice, automation of frailty scoring, and expansion into advanced practice to improve quality of care and reduce cost of care.
Source: Zimmerman P. Nephrology Nursing Journal, 2025; 52(4): 373-386
Source: Zhou X. Journal of Clinical Nursing, Dec 2025; 34(12): 5315-5327
Utilizing Frailty Assessment to Impact Nursing Care for Patients with End Stage Kidney Disease: A Quality Improvement Project
Abstract: Frailty is highly prevalent in patients with end stage kidney disease (ESKD) and predictive of morbidity. Nurses lack frailty education and face practical challenges to assessment, which prevent effective interventions to address frailty. A quality improvement project sought to determine if frailty education and utilization of a renal frailty index tool impacts telephonic case management nursing care of patients by improving knowledge, perception, identification, and assessment of frailty, thereby prompting nursing interventions. Positive impacts were seen across all outcomes influencing outreach and resource utilization by nurses. Limitations included a small sample size, time burden, and manual processes. Findings suggest the importance of embedding frailty care into daily practice, automation of frailty scoring, and expansion into advanced practice to improve quality of care and reduce cost of care.
Source: Zimmerman P. Nephrology Nursing Journal, 2025; 52(4): 373-386
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Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
BACKGROUND: The pooled prevalence of frailty in maintenance hemodialysis patients is increasing, and research on the effects of intradialytic exercise to improve frailty remains limited.
OBJECTIVES: To analyze the effects of intradialytic exercise on frailty in maintenance hemodialysis patients through randomized clinical trials and quasi-experimental studies. METHODS: We performed a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library, and English-language publications were indexed from January 2010 to August 2024. Statistical analyses were performed using Review Manager V.5.3 and STATA 15.0. Statistical heterogeneity among studies was quantified using the Chi-square and I-square tests, and publication bias was evaluated using Egger's test and funnel plots. RESULTS: 31 studies involving 1,365 maintenance hemodialysis patients were included. The data from the meta-analysis showed that intradialytic exercise significantly reduced frailty score (MD = -0.98, 95%CI: 1.90 to -0.06, p = 0.04) and fatigue (SMD = -0.47, 95%CI: 0.72 to -0.23, p = 0.0001). Also, intradialytic exercise significantly increased grip strength (MD = 2.42, 95%CI:0.78 to 4.06, p = 0.004), 6-min walking distance (MD = 36.65, 95%CI:24.90 to 48.39, p < 0.0001), and step counts (SMD = 0.32, 95%CI:0.04 to 0.60, p = 0.03). However, no significant effects were found in body weight (MD = 0.71, 95%CI: 1.28 to 2.69, p = 0.48). CONCLUSION: Intradialytic exercise can significantly improve overall frailty and frailty indicators such as grip strength, 6-min walking distance, step counts, and fatigue. Thus, intradialytic exercises might be a viable strategy for frailty in maintenance hemodialysis patients.
SYSTEMATIC REVIEW REGISTRATION: CRD42024576582.
Source: Zou Zhao H. Frontiers in Physiology, Nov 2025; 16: 1600219
A review of the impact of exercise on fall rates among community-dwelling older adults
Abstract:
Source: Zou Zhao H. Frontiers in Physiology, Nov 2025; 16: 1600219
A review of the impact of exercise on fall rates among community-dwelling older adults
Abstract:
Background: The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives. Studies show that exercise can improve balance and build muscle mass. The challenge is prescribing safe and evidence-based exercise regimens to older adults.
Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.
Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.
Data sources: This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.
Implications for practice: The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
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