Cognitive frailty and adverse outcomes in older people with maintenance hemodialysis: a multicenter prospective...

To explore the impact of cognitive frailty on falls, readmissions, and mortality in aged patients undergoing Maintenance Hemodialysis (MHD).

A prospective cohort study.

We collected baseline data from September 2023 to January 2024. We assessed cognitive frailty at baseline using the Frailty Scale and Montreal Cognitive Assessment. Older adults receiving MHD were followed for 12 months, with assessments at 6 and 12 months. Mortality was the primary outcome; falls and readmissions were secondary outcomes. We assessed adverse outcomes through multiple methods: mortality data were obtained via hospital electronic medical record system queries, dialysis registry platform verification, and confirmation by medical staff; falls and readmissions were ascertained through face-to-face interviews with patients during dialysis sessions, supplemented by hospital medical record system queries. We used the χ² test to compare group differences in adverse outcome rates, the Kaplan-Meier method with the log-rank test to estimate monthly cumulative event probabilities, and Cox regression to assess the association between cognitive frailty and the three adverse outcomes.

Of 1,023 older adults on MHD, 300 (29.3%) had cognitive frailty. The other 723 (70.7%) did not. In 12 months, there were 101 deaths (9.8%), 190 falls (18.6%), and 299 readmissions (29.2%). The cognitive frailty group had higher incidences of death (59 [19.7%] vs. 42 [5.8%]), falls (94 [31.3%] vs. 95 [13.1%]), and readmissions (129 [43.0%] vs. 170 [23.5%]). After adjusting for confounders, cognitive frailty remained an independent risk factor for mortality (HR = 2.716, 95% CI 1.754-4.205, P < 0.001), falls (HR = 2.021, 95% CI 1.471-2.777, P < 0.001), and readmissions (HR = 1.996, 95% CI 1.585-2.514, P < 0.001).

Cognitive frailty independently increases risk for mortality, falls, and hospital readmission in older adults undergoing MHD. Strengthen screening and assessment for cognitive frailty to help identify high-risk patients early and inform targeted interventions.