Prevalence and factors associated with pre-frailty and frailty in hemodialysis patients in central China: a multicentre cross-sectional study
Authors: Jiang Sufang , Zhou Yumei , Zhang Nanhui , Zhang Shan , Xie Yunhan , Qiu Qianqian , Qiu Xiaofan , Jiang Ying , Rao Longhua 
Published: June 2024

Aims:The current study aimed to explore the prevalence and risk factors elements of pre-frailty and frailty among patients undergoing hemodialysis (HD) in central China.
Design:A cross-sectional, multi-institutional investigation was conducted.
Method: From March to May 2024, using the convenience sampling method, a total of 408 hemodialysis patients from four hospitals in Xiangyang, China, were recruited for this study. The participants'demographic, lifestyle factors and Factors related to dialysis treatment were assessed using a general information questionnaire. Frailty was evaluated based on The Frail Scale. Psychological resilience was evaluated based on CD-RISC. Medical coping modes was evaluated based on MCMQ. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population, including age, sex, height, weight, religion, marry status, with children, education level, residential situation, employment, monthly household income, smoking status, drinking status, exercise, dialysis duration, dialysis frequency, falls, vascular access, hypertension, diabetes, heart disease, cerebral disease and other diseases. Furthermore, to evaluate the independent relationship between frailty and psychological resilience, multiple regression analysis was used to adjust potential confounders and obtain odds ratios (ORs) and 95% confidence intervals (CIs). Pearson correlation analysis was used to correlation analysis among various scales.
Results:Among the 408 participants with an average age of 59.00(47.00,69.00) years. The prevalence of pre-frailty and frailty among participants for all ages were 26.2% and 38.5%. Multivariate logistic regression analysis showed that weight, smoking status, falls, heart disease and Psychological resilience are associated with pre-frailty. Multivariate logistic regression analysis showed that age, having child, education level, monthly household income,smoking status, drinking status, exercise, falls, vascular acces, diabetes, heart disease, cerebral disease, resignation and psychological resilience are associated with frailty. The Pearson correlation analysis showed that resignation is positively related to frailty and negatively related to psychological resilience in patients. Confrontation and Avoidance were positively related to psychological resilience.Frailty was negatively related to psychological resilience. Psychological resilience were independently linear associated with pre-frailty (OR=0.49, 95%CI0.32-0.75, p<0.001) and frailty(OR=0.53, 95%CI0.35-0.80, p=0.003) .
Conclusion:Our findings point to the necessity for active screening for pre-frailty (26.2%) and frailty (38.5%) in adult hemodialysis patients of all ages. Frailty is positively associated with increasing age, poor monthly household income, smoking, drinking, non-exercise, falls, various vascular access, diabetes, heart disease, cerebral disease, resignation, and low psychological resilience.Weight gain, smoking, falls, heart disease, and a lack of psychological resilience are all related with pre-frailty.Pre-frailty and frailty among hemodialysis patients are associated with lower psychological resilience and a higher likelihood of using negative coping mechanisms. As a result, medical workers must give patients with greater health education and psychological support in order to boost their confidence in illness prevention and improve their quality of life.