TOPLINE:

Frailty increased during the first year after the initiation of dialysis in patients with end-stage kidney disease. Pre-dialysis frailty was associated with an increased risk for hospitalisation, and an increase in the frailty score during the first 6 months of dialysis was linked to a higher risk for mortality.

METHODOLOGY:

• Researchers conducted a study to describe changes in frailty from the initiation of dialysis over the first year of treatment and to examine the association of frailty and its change over time with mortality and hospitalisation.
• This study included 293 patients with end-stage kidney disease (median age at dialysis initiation, 68 years; 35.1% women), of whom 191 (65%) underwent haemodialysis and 102 (35%) underwent peritoneal dialysis.
• A Clinical Frailty Scale (CFS) score was recorded by nephrologists and renal nurses within 6 months before and/or 6-12 months after the initiation of dialysis; data on demographics, primary renal disease, BMI, dialysis modality, Charlson Comorbidity Index, mortality, and the number of hospitalisations were collected.
• The primary outcome was changes in the frailty score from baseline (6 months prior to the initiation of kidney replacement therapy) to 6 and 12 months after the initiation of dialysis.
• Secondary outcomes included associations of the frailty score and its change over time with hospitalisations and mortality.

TAKEAWAY:

• Frailty increased over the first year after starting dialysis, with a mean rise in the CFS score of 0.18 per 6 months (95% CI, 0.06-0.31), regardless of age, sex, comorbidity, or dialysis modality.
• Frailty prior to the initiation of dialysis (CFS score ≥ 5) was associated with an increased number of hospitalisations per month compared with non-frailty (P = .011).
• An increase in the frailty score between pre-dialysis and 6 months was associated with a 35% increased risk for mortality (adjusted hazard ratio, 1.35; 95% CI, 1.01-1.80).

IN PRACTICE:

"[The study] findings underline the importance of pre-dialysis frailty screening in order to inform prognosis and patient counselling in ESKD [end-stage kidney disease]. Our data suggests that those with a CFS ≥ 5 are at increased risk and would benefit from early identification," the authors wrote.

SOURCE:

This study was led by Kerry-Lee Rosenberg, University College London, London, England. It was published online on October 08, 2025, in Scientific Reports.

LIMITATIONS:

A major limitation of this retrospective study was missing data; the timing and frequency of CFS score recordings were based on clinical judgement. Moreover, variation in the application of the CFS score may have existed between clinical staff. This study did not assess the level of available social support, which may have influenced frailty trajectory and hospitalisation.

DISCLOSURES:

This study did not report any source of funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.