Clinical and experimental nephrology · 2026
Long-term frailty progression and mortality in hemodialysis: Impact of dialysis duration and baseline frailty in a nationwide Japanese cohort.
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Niihata Kakuya, Kurita Noriaki, Inanaga Ryohei, Toida Tatsunori, Abe Masanori, Masaki Takao, Yamamoto Suguru
Аннотация
BACKGROUND: Long-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.
METHODS: This 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.
RESULTS: Over 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.
CONCLUSIONS: Long-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.
METHODS: This 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.
RESULTS: Over 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.
CONCLUSIONS: Long-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.