Cheng Zhou

Background: The number of dialysis patients in China is rapidly increasing, with the proportion of older adults aged ≥ 60 years rising, linked to population aging and longer dialysis duration. This study investigated frailty prevalence in Chinese maintenance hemodialysis (MHD) patients, analyzed its status, risk factors and correlation with long-term survival in older dialysis patients to provide evidence for frailty interventions. Methods: A total of 391 patients were assessed for frailty using the Frailty Screening Scale. Demographic, clinical, and biochemical data were collected, with 24-month follow-up for survival. Multivariate regression and Cox regression models were used for analyses. Results: The cohort comprised 222 male patients (56.9%), with a mean age of 61 ± 13.9 years and a median dialysis vintage of 4 (2.0, 8.5) years. Patients aged ≥ 60 years accounted for 57.5% of participants. Frailty assessment showed that 85.3% of older patients had varying degrees of frailty, and 52.7% were in the pre-frail status. Increased age and low albumin level were identified as clinical correlates of frailty. During the 24-month follow-up period, a total of 88 deaths occurred. Regression analysis showed that patients under maintenance hemodialysis with frailty syndrome had a 3–5-fold higher mortality risk compared with non-frail individuals, and this association was more prominent in the elderly population aged over 60 years. Compared with patients with frailty syndrome, individuals in the pre-frail stage had markedly reduced mortality ( P = 0.009, P = 0.006). Conclusion: Frailty is highly prevalent in older hemodialysis patients and closely correlated with increased mortality. Early frailty screening and risk stratification are essential for older dialysis patients and individuals at high risk of adverse clinical events. This study highlights the clinical value of early identification and standardized management of frailty, which can provide evidence for clinical diagnosis and treatment in this vulnerable population.

Cardiovascular disease (CVD) events are the main cause of death in long-term hemodialysis (HD) patients. Macrophage colony- stimulating factor (M-CSF) is actively involved in the formation of atherosclerosis and causes plaque instability, thrombosis and the development of acute coronary syndromes. However, little information is available on the role of M-CSF in HD patients. We aimed to investigate the association between plasma M-CSF levels and CVD events as well as all-cause mortality in patients undergoing long-term HD. Fifty two HD patients and 8 healthy controls were recruited in this study. HD patients were followed up from September 2014 to May 2017. The primary end point was CVD event, the secondary outcome was death from any cause. Patients were divided into two groups with low and high M-CSF levels based on the optimal cut-off value determined by the ROC curve. Cox regression analyses were used to assess the predictive value of plasma M-CSF for CVD events and all-cause mortality in HD patients. We tested the levels of plasma M-CSF and other inflammatory cytokines in surviving HD patients using ELISA or CBA kit. The average plasma level of M-CSF in 52 patients was approximately twice that of healthy controls (992.4 vs. 427.2 pg/mL; p < 0.05). During 32 months of follow-up, 26 patients (50.0%) had at least one CVD event and 8 patients (15.4%) died. The mean plasma M-CSF concentration increased in survivors after follow-up compared to that detected at baseline (1277.8 ± 693.3 vs. 997.2 ± 417.4 pg/mL; p < 0.05). Multivariate Cox regression analysis showed that plasma M-CSF is an independent risk factor for CVD events in HD patients (p < 0.05). In the Cox regression model after adjusting for gender and age, high M-CSF levels were related to an increased risk of all-cause death (p < 0.05). We also found that M-CSF levels were positively correlated with IL-6 and IL-18 levels (both p < 0.05), which are the major pathogentic cytokines that contribute to HD-related CVD events. M-CSF is a prognostic factor for CVD events and all-cause mortality in HD patients.