ArticleBMC nephrology2026
Association between frailty and MACE and all-cause mortality in Chinese maintenance haemodialysis patients: a retrospective cohort study.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFrailty is common among patients undergoing maintenance haemodialysis (MHD) and is linked to multiple adverse outcomes, including increased mortality. However, large-scale cohort studies in China on the associations between frailty and major adverse cardiovascular events (MACE) as well as all-cause mortality in patients undergoing haemodialysis are lacking. This study aimed to investigate the associations between frailty and MACE and all-cause mortality in this population.
methodsThis single-centre retrospective cohort study enrolled patients on haemodialysis at the First Affiliated Hospital, Zhejiang University School of Medicine, from August 2020 to December 2021, with follow-up until August 31, 2025. Frailty status was assessed using the Fried Frailty Scale. Endpoints included the occurrence of all-cause mortality and MACE. A competing risk model was used to examine the associations between frailty and both MACE and all-cause mortality. Additionally, multidimensional sensitivity analyses were performed to assess the robustness of the findings.
resultsThis study encompassed a cohort of 810 patients undergoing maintenance haemodialysis (MHD). The cumulative incidence of major adverse cardiovascular events (MACE) over five years was 33.0% (95% CI: 26.1-39.8%), while the cumulative incidence of all-cause mortality was 61.0% (95% CI: 53.4-68.7%). Both incidences were significantly elevated in the frail patient group compared to their non-frail counterparts (P < 0.001). Following multivariable adjustment, the Fine-Gray competing risk model revealed that frail patients exhibited a 4.96-fold increased risk of MACE (95% CI: 2.50-9.85; P < 0.001) and a 3.35-fold increased risk of all-cause mortality (95% CI: 2.10-5.35; P < 0.001), underscoring a significant positive association. Sensitivity analyses corroborated that frailty remained significantly associated with both MACE and all-cause mortality.
conclusionFrailty demonstrated a significant correlation with an increased risk of MACE and all-cause mortality in patients undergoing MHD, with the risk escalating in a linear manner in accordance with the severity of frailty.
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