Clinical, functional, and immunological profiles across frailty subgroups in maintenance hemodialysis patient.

BACKGROUND

Frailty is a common syndrome in maintenance hemodialysis (MHD) patients, characterized by diminished physiological reserves and adverse health outcomes. This study explored the associations between clinical, functional, and immunological characteristics across frailty subgroups to improve understanding and guide interventions.

METHODS

The single-center observational study included 66 MHD patients categorized into three frailty groups (Normal, Pre-Frailty, Frailty) using Fried FRAIL scale scores. Demographic, clinical, and laboratory data, including physical performance measures, biochemical markers, and immune parameters, were collected. Immune cell subsets and inflammatory cytokines were analyzed via flow cytometry. Subgroup comparisons and correlations between immune and biological age were examined.

RESULTS

Frailty was associated with older age, reduced grip strength, lower physical activity, and higher fall prevalence. Frail patients were older (64.19 ± 14.37 years) with lower grip strength (18.00 [13.60-22.60] kg) compared to Normal patients (26.70 [20.90-30.20] kg, p < 0.001). Elevated ferritin (207.00 [106.50-297.50] μg/L) and HbA1c (6.58 ± 1.75%) levels were observed in the Frailty group. Immune markers, including effector memory CD4+ T cells, central memory CD8+ T cells, and Th1/Th2 ratios, varied significantly. Immune age correlated strongly with biological age in Normal (r = 0.98) and Pre-Frailty groups (r = 0.96), but weakened in the Frailty group (r = 0.84), suggesting immune dysregulation.

CONCLUSIONS

Frailty in MHD patients is linked to distinct clinical, functional, and immunological differences. Immune age may complement traditional frailty measures as a biomarker for assessment and monitoring. A multidimensional approach could improve early detection, risk stratification, and targeted interventions.