Frailty in older maintenance hemodialysis patients: A latent class analysis revealing personalized management
Fangping Chen, Xingyue Guo, Dingyuan Wei, Mengxing Wang, Jiayan Wang, Didi Xu, Luyang Jin, Surui Liang, Siyi Li, Xuemei Xian
Abstract
Elderly patients undergoing maintenance hemodialysis (MHD) exhibit an elevated risk of frailty, which is strongly associated with adverse clinical outcomes, including increased mortality. However, current frailty assessment tools often overlook intrinsic patient heterogeneity, limiting their clinical utility.
Introduction
Chronic kidney disease (CKD) is an increasing global public health priority linked to significantly elevated morbidity and mortality rates [1,2]. The prevalence of end-stage kidney disease (ESKD), a progressive consequence of CKD, is also increasing [3].
Materials and methods
This cross-sectional study was conducted at Shenzhen Hospital of Southern Medical University, Guangdong Province, China, and adhered to the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethical Review Board of Shenzhen Hospital of Southern Medical University (Approval number: NYSZYEC20240002).
Results
An effective response rate of 94.58% was achieved by distributing a total of 240 questionnaires, of which 227 were deemed valid. Among the 227 elderly patients who received MHD, the average age was 71.91 years (SD = 8.08), with males accounting for the majority (59.0%).
Discussion
In this study, two frailty phenotypes among elderly MHD patients were identified using LCA. Class 1 was characterized by low physical activity and high frailty. Class 2 was characterized by high physical activity and low frailty. Firth logistic regression revealed that combined hypertension, older age, longer dialysis duration, lower serum albumin concentration, and lower serum creatinine concentration were independently associated with the high-frailty phenotype.
Conclusion
Using LCA, this cross-sectional study identified two distinct frailty phenotypes among elderly MHD patients: a low physical activity–high frailty group and a high physical activity–low frailty group. Older age, longer dialysis duration, combined hypertension, lower serum albumin concentration, and lower serum creatinine concentration were significantly associated with the high-frailty phenotype.
Citation: Chen F, Guo X, Wei D, Wang M, Wang J, Xu D, et al. (2026) Frailty in older maintenance hemodialysis patients: A latent class analysis revealing personalized management. PLoS One 21(6): e0351155. https://doi.org/10.1371/journal.pone.0351155
Editor: Mohamed K. Hassan, Qatar University, QATAR
Received: November 21, 2025; Accepted: May 23, 2026; Published: June 16, 2026
Copyright: © 2026 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The minimal anonymized data set underlying the findings of this study has been uploaded as a Supporting Information file.Access to additional individual-level data is restricted by the Ethical Review Board of Shenzhen Hospital of Southern Medical University (Approval number: NYSZYEC20240002) because of the sensitive nature of clinical data from elderly hemodialysis patients. Data requests may be sent to the Ethics Committee of Shenzhen Hospital of Southern Medical University (Address: 1333 Xinhu Road, Bao’an District, Shenzhen, Guangdong, China) or to the corresponding author (xianxuemei@zju.edu.cn).
Funding: This study was funded by the “Double First-Class” Construction Specialized Discipline Project at Zhejiang University (HL2024012), and the Bao’an District Healthcare Research Program (2022JD026). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
