Oral Frailty and Health-Related Quality of Life in Maintenance Hemodialysis Patients.

BACKGROUND

Oral frailty may adversely affect health-related quality of life (HRQOL) in patients receiving maintenance hemodialysis, but evidence in dialysis populations remains limited. We examined the association between oral frailty and HRQOL and explored potential indirect pathways through nutritional status, depressive symptoms, and functional status.

METHODS

This cross-sectional study analyzed baseline data from 350 adults receiving maintenance hemodialysis in the Fukushima Dialysis Cohort Study. Oral frailty was defined as an Oral Frailty Index-8 score ≥4. HRQOL was assessed using the Japanese EQ-5D-5L index. Linear regression models with multiple imputation were used to examine the association between oral frailty and logit-transformed EQ-5D-5L values. Exploratory mediation analyses evaluated the Geriatric Nutritional Risk Index, Patient Health Questionnaire-9, and performance status.

RESULTS

Oral frailty was independently associated with lower HRQOL in the fully adjusted model (β = -0.403, 95% confidence interval -0.606 to -0.199; P < 0.001). In single-mediator analyses, indirect effects through depressive symptoms and performance status were significant, whereas the indirect effect through nutritional status was not. In the parallel structural equation model, indirect associations through depressive symptoms and performance status remained significant, while the nutritional pathway was not supported.

CONCLUSIONS

Oral frailty was independently associated with lower HRQOL in maintenance hemodialysis patients. Exploratory mediation analyses showed significant indirect effects through depressive symptoms and performance status, but not through nutritional status. Oral frailty screening may facilitate timely dental and multidisciplinary care to preserve HRQOL, although prospective evaluation is needed.