Long-term frailty progression and mortality in hemodialysis: Impact of dialysis duration and baseline frailty in a nationwide Japanese cohort.

backgroundLong-term transitions in physical function among patients receiving hemodialysis remain poorly characterised. We aimed to describe 8-year trajectories of physical function and examine their associations with baseline dialysis duration and physical function status.

methodsThis nationwide cohort study analysed data from 223,501 Japanese adults undergoing hemodialysis registered in the 2010 Japanese Society for Dialysis Therapy Renal Data Registry. Baseline dialysis duration was categorised as < 5, 5- < 10, 10- < 20, 20- < 30, or ≥ 30 years. Physical function at baseline was assessed using the Eastern Cooperative Oncology Group Performance Status and classified as non-frail, frail, or bedridden. Physical function at 8 years was categorised as non-frail, frail, bedridden, or deceased. Multinomial logistic regression estimated adjusted odds ratios, average marginal effects, and predicted probabilities.

resultsOver 8 years, 59.9% died, 8.8% became frail, 2.4% were bedridden, and 28.9% remained non-frail. Longer dialysis duration and baseline frailty or bedridden status were associated with higher odds of subsequent frailty, bedridden status, and mortality. Compared with patients with < 5 years of dialysis, those with ≥ 30 years had a 1.6% higher probability of frailty and a 13.2% higher probability of death. Compared with baseline non-frail status, frailty was associated with a 0.04% change in frailty and a 15.8% increase in death; bedridden status was associated with a 1.7% increase in being bedridden and a 26.0% increase in death.

conclusionsLong-term dialysis duration and baseline physical function strongly influence mortality, whereas absolute frailty progression is modest. These findings support early, values-based shared decision-making in dialysis care.