Independent Factors Associated with Frailty Among Older Adults Undergoing Maintenance Hemodialysis: A Cross-Sectional Study

Abstract

Frailty is a multidimensional syndrome characterized by reduced physiological reserve and increased vulnerability to stressors and is commonly observed among patients with chronic kidney disease undergoing hemodialysis (HD). Frailty is associated with increased morbidity, mortality, and poorer quality of life. Identifying factors associated with frailty among older adults receiving HD is essential for early detection and intervention. This analytical observational study employed a cross-sectional design and was conducted at the Hemodialysis Unit of Dr. Kariadi General Hospital from February to April 2026. Sixty older adults (>60 years old) receiving maintenance HD were enrolled according to predefined inclusion and exclusion criteria. Frailty was assessed using a 40-item frailty index. Independent variables included Charlson Comorbidity Index (CCI), nutritional status, depression, and physical activity level. We used bivariate analysis with Chi-square tests with continuity correction, and multivariate analysis with binary logistic regression. Statistical significance was defined as p <0.05. Frailty prevalence was 53.3%. Bivariate analysis demonstrated significant associations between low physical activity ( p <0.001; PR = 9.435), CCI ≥5 ( p = 0.011; PR = 2.333), malnutrition ( p = 0.025; PR = 1.894), and frailty. Multivariate analysis identified low physical activity (OR = 23.506; p = 0.008), malnutrition (OR = 6.811; p = 0.047), and CCI ≥5 (OR = 5.086; p = 0.030) as independent factors associated with frailty. Low physical activity, malnutrition, and greater comorbidity burden were independently associated with frailty, with low physical activity identified as the strongest factor.