Electromyographic findings and frailty in hemodialysis vs peritoneal dialysis patients

To compare the effects of hemodialysis (HD) and peritoneal dialysis (PD) on peripheral nervous system function and frailty in non-diabetic end-stage renal disease (ESRD) patients.

This prospective, single-center, cross-sectional study consecutively enrolled 88 non-diabetic ESRD patients (HD: n = 45, PD: n = 43) receiving dialysis for ≥3 months at Bursa City Hospital between 1 May and 16 September 2025. All underwent neurological examination and nerve conduction studies. Frailty was assessed using the Fried Frailty Phenotype (FFP), classifying patients as robust (0), pre-frail (1-2) or frail (≥3). Multivariable linear regression identified independent correlates of frailty score.

Median age was 57 (HD) versus 52 years (PD) (p = 0.077). HD patients had higher potassium (5.1 ± 0.7 vs 4.7 ± 0.6 mmol/L, p = 0.025) and ferritin (763 vs 406.5 ng/mL, p < 0.001) and a trend toward higher CRP (8.1 vs 3.2 mg/L, p = 0.075). PD patients showed better dialysis adequacy (Kt/V 1.9 vs 1.6, p < 0.001) and a trend toward higher sural sensory conduction velocity (54 vs 48 m/s, p = 0.052). Axonal polyneuropathy predominated (37.5%), without difference between modalities. Median FFP score was 1 in both groups (p = 0.705), but frailty-category distribution differed (frail: HD 20.0% vs PD 6.9%, p = 0.047). Univariately, CRP correlated with frailty in HD (rs = 0.31, p = 0.038); age (rs = 0.34, p = 0.041), hemoglobin (rs = 0.39, p = 0.014) and Kt/V (rs = -0.37, p = 0.027) correlated in PD. In multivariable regression, CRP remained an independent correlate (B = 0.017, 95% CI 0.001-0.033, p = 0.042).

Although median FFP scores were similar, frailty distribution and its correlates differed by modality - inflammation in HD, age, and dialysis adequacy in PD. These hypothesis-generating findings warrant larger multicenter evaluation.