Background 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. Materials and Methods 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. Results 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. Conclusions Low physical activity, malnutrition, and greater comorbidity burden were independently associated with frailty, with low physical activity identified as the strongest factor.
Background Protein-energy wasting (PEW) is a well-recognized metabolic condition in chronic kidney disease (CKD) and is associated with morbidity, mortality, hospitalization, and rapid progression to dialysis dependence. Its pathogenesis is multifactorial; however, data regarding the association of inadequate dietary intake, inflammation, and oxidative stress (OS) markers associated with PEW in pre-dialysis CKD (PD-CKD) stages remain limited in Indian populations. This study aimed to examine the association of inadequate dietary intake and oxidative and inflammatory markers with PEW and evaluate factors independently associated with PEW in patients with PD-CKD. Materials and Methods A cross-sectional observational study enrolled 224 patients with PD-CKD. PEW was diagnosed according to the ISRNM criteria; 3-day dietary recall, inflammatory markers (IL-6, TNF-α, CRP, and IL-10), and OS markers (GR, SOD, and MDA) were measured by ELISA. Multivariable regression analysis was performed to evaluate independently associated factors with PEW after adjustment for age, sex, eGFR and hypertension. Results PEW prevalence was 45.5% among patients with PD-CKD stages 2–5. Multivariable regression analysis after adjustment for age, sex, eGFR and hypertension revealed that TNF-α (AOR = 1.086, p = 0.013), GR (AOR = 1.137, p = 0.002), SOD (AOR = 0.054, p <0.001), and MDA (AOR = 1.115, p = 0.016) remained significantly associated with PEW, whereas IL-6 showed a borderline association ( p = 0.055). Conclusion PEW was evident as early as CKD stage 2. Persistent inflammation and OS were significantly associated with PEW, highlighting the combined effect of metabolic, inflammatory, and nutritional burden with declining eGFR in patients with PD-CKD.
