Frailty may predict Cardiovascular Risk and Mortality in Maintenance Hemodialysis: Study

A new study published in the journal of BMC Nephrology revealed that frailty is significantly associated with a higher risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients undergoing maintenance hemodialysis (MHD). The risk increases progressively in a linear fashion with greater severity of frailty, highlighting its importance as a prognostic indicator in this population

Frailty is marked by reduced strength, endurance, and physiological function, which is already known to be common among patients with chronic kidney disease. However, large-scale evidence examining its direct relationship with serious cardiovascular outcomes and survival in hemodialysis patients has been limited, particularly in China. 

The single-centre retrospective cohort study followed 810 patients who were receiving hemodialysis at a major hospital between August 2020 and December 2021. This research assessed frailty using the widely recognized Fried Frailty Scale, by categorizing patients based on their physical vulnerability. The primary outcomes measured were MACE (including heart attacks and strokes) and all-cause mortality.

Over a 5-year period, the cumulative incidence of MACE reached 33%, while overall mortality climbed to 61%. Both outcomes were significantly more common among patients identified as frail when compared to those who were not. Statistical analysis revealed that frail individuals faced nearly 5-times the risk of experiencing MACE and more than 3-times the risk of death from any cause.

This study employed a Fine–Gray competing risk model, to account for overlapping risks like death when evaluating cardiovascular events. Even after adjusting for multiple variables, the strong association between frailty and adverse outcomes remained consistent. 

This study found a linear relationship between frailty severity and risk levels. As frailty worsens, the risk of both cardiovascular events and death increases proportionally. This suggests that even modest improvements in frailty status could potentially translate into meaningful health benefits.

These findings emphasize the importance of routine frailty screening in dialysis patients. Identifying at-risk individuals early could allow physicians to implement interventions like nutritional support, physical rehabilitation, and closer cardiovascular monitoring.

Despite being a single centre study, its relatively large sample size and extended follow-up period lend weight to its conclusions. Further multicentre studies could help validate the findings across greater populations. Overall, the research adds to growing data that frailty is not just a marker of poor health, but a critical factor influencing outcomes in patients who undergo hemodialysis.

Source:

Ying, J., Chen, L., Liang, J., Zhang, L., Ye, J., Bao, H., Zhu, J., Zhang, Y., Cai, G., & Zhang, P. (2026). Association between frailty and MACE and all-cause mortality in Chinese maintenance haemodialysis patients: a retrospective cohort study. BMC Nephrology. https://doi.org/10.1186/s12882-026-04984-0