Frailty Associated with Cardiovascular Mortality in Hemodialysis Patients.

Background: Cardiovascular disease is the leading cause of mortality among hemodialysis patients. Frailty, characterized by diminished physiological reserve, is increasingly recognized as an important risk factor for adverse outcomes in this population. Objectives: This study aimed to investigate the role of frailty in cardiovascular mortality among patients undergoing maintenance hemodialysis. Methods: This prospective cohort study enrolled 1,136 hemodialysis patients from 12 centers in Hsinchu, Taiwan. Baseline data on demographics, comorbidities, dialysis-related factors, and laboratory results were collected. Frailty was assessed using modified Fried frailty criteria, and the patients were followed for a median of 1,187 days. Cardiovascular death was the primary outcome, with a particular emphasis on sudden cardiac death. Cox proportional hazards models were used to analyze the data. Results: Of the 1,136 participants, 34.3% were classified as frail. The frail patients had significantly higher rates of cardiovascular death [25% vs. 12%, hazard ratio (HR) = 2.34, p < 0.001] and sudden cardiac death (16% vs. 6%, HR = 3.12, p < 0.001) compared to the non-frail patients. Multivariate analysis confirmed frailty as an independent predictor of cardiovascular death (HR = 1.62, 95% confidence interval 1.20, 2.19, p = 0.002). The association between frailty and sudden cardiac death was more pronounced than that between frailty and non-sudden cardiac death. Conclusions: Frailty was a strong predictor of cardiovascular mortality, and particularly sudden cardiac death, in the enrolled hemodialysis patients. These findings underscore the importance of frailty assessments and targeted interventions to reduce cardiovascular risk in this vulnerable group. Further research is needed to elucidate the mechanisms linking frailty with cardiovascular outcomes and to develop effective management strategies.