A newly developed frailty index predicts hospitalization and mortality among older adults receiving dialysis.

Using the United States Renal Data System data, investigators identified 53 health deficits among 20,974 community-dwelling adults aged 65 years or older who survived at least 6 months on dialysis during 2013. The deficits comprised disabilities, diseases, equipment, procedures, signs, tests, and unclassified factors.

Based on these deficits, the investigators created a frailty index. The mean frailty index was 0.30 on a scale from 0 to 1. Frailty increased with age and was higher in women than men. The index was able to capture recent acute events such as ambulance use.

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Over 12 months, 11,493 patients were hospitalized (55%) and 3842 patients (18%) died. Each 0.1-point increment in the frailty index was significantly associated with a 33% increased risk of a first hospitalization and a 41% increased risk of death, Rasheeda Hall, MD, MBA, MHS, of Duke University School of Medicine in Durham, North Carolina, and colleagues reported in Kidney360.

The frailty index predicted mortality and hospitalization similar to a dialysis-specific comorbidity index. The Harrell’s C-statistic of the novel frailty index, a comorbidity index, and both indices combined were 0.65, 0.65, and 0.66, respectively, for death and 0.61, 0.60, and 0.61, respectively, for hospitalization. The frailty index predicted mortality even after adjusting for age, sex, and comorbidities. The investigators obtained consistent results in a validation cohort of 21,355 patients receiving dialysis during 2017.

Dr Hall’s team acknowledged that additional research is needed to improve the frailty index for clinical application in dialysis. For example, laboratory test abnormalities and physical or cognitive function assessments, which were not available in this study, would enhance the index. The investigators also need to refine the list of health deficits.

“Because the frailty index utilizes data that has already been collected, it has high potential to be used for population health management to screen for the most vulnerable patients,” the investigators wrote. “Such screening can be used to optimize resource allocation for both medical and population health services, such as comprehensive geriatric assessment and social services. Access to those services has potential to limit functional impairment which could delay or prevent long-term care.”

The study population was community dwelling older adults, which may have introduced survival bias. According to the investigators, the index is better suited to a prevalent rather than an incident dialysis population.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hall R, Morton S, Wilson J, et al. Development of an administrative data-based frailty index for older adults receiving dialysis. Kidney360. Published online July 19, 2022. doi:10.34067/KID.0000032022