Frailty and peripheral neuropathy in hemodialysis patients: clinical and electrophysiological correlations

Frailty is highly prevalent in chronic kidney disease patients and associated with mortality. We investigated the relationship between frailty and peripheral neuropathy in hemodialysis patients.

We enrolled 70 maintenance hemodialysis patients and assessed physical frailty using the five-criteria Fried frailty index. Motor and sensory nerve conduction studies were performed on median, ulnar, peroneal, tibial, and sural nerves. Neuropathy severity was measured using the Total Neuropathy Score (TNS). ANCOVA was performed to control for age and cardiovascular disease as confounders.

Patients were categorized as non-frail (n = 25), pre-frail (n = 26), and frail (n = 19). Frail patients were significantly older and had higher cardiovascular disease prevalence. TNS increased progressively across groups (median values: 3 vs 10.5 vs 13, p < .001). After controlling for age and cardiovascular disease, frailty status remained significantly associated with TNS (F(2,65)=6.415, p = .003, partial η² = 0.165). Electrophysiological studies showed significantly reduced nerve conduction parameters in frail patients. Frailty score strongly correlated with TNS (r_s = .48, p < .001). Subgroup analysis in non-diabetic patients confirmed this relationship independent of diabetes status (p = .024).

Frailty and peripheral neuropathy demonstrate a strong, independent association in hemodialysis patients that persists after controlling for major confounders. This relationship exists regardless of diabetes status, suggesting peripheral nerve dysfunction is an integral component of frailty in this population. Early recognition could enable targeted interventions to improve outcomes in vulnerable hemodialysis patients.