The impact of frailty and malnutrition on hospitalisation and survival in people with kidney failure

TL;DR

This study examines how frailty and malnutrition affect hospitalization and survival in elderly patients with kidney failure, comparing those on conservative management and dialysis.

Contribution

The study identifies malnutrition as a significant predictor of mortality in conservative kidney management patients, independent of frailty.

Findings

Frailty was linked to more frequent and longer hospital stays, primarily in dialysis patients.

Malnutrition was associated with reduced 2-year survival in conservative kidney management patients.

Frailty did not significantly affect mortality in conservative kidney management patients.

Abstract

Malnutrition and frailty are common, with rates increasing as kidney disease progresses and with ageing. Conservative kidney management has emerged as a kidney failure treatment that prioritises quality of life and symptom management, typically offered to the elderly. The aim of this study was to determine the incidence and impact of frailty and malnutrition on hospitalisations, quality of life and mortality in people with kidney failure.

This two-year longitudinal study recruited people choosing conservative kidney management and, as a comparator group, people aged 75 years and over who were commenced on dialysis. Participants underwent assessment of frailty, nutritional status and quality of life every 6 months. Hospitalisation and death data were extracted from medical records.

A total of 85 participants were recruited (n = 60 conservative kidney management, n = 25 dialysis). At baseline, 56% were assessed as frail and 33% as malnourished. In the total cohort, frailty was associated with a higher rate of hospitalisations, and longer hospital stays. These associations appeared to be driven by the dialysis group, as no differences in hospitalisation rates or length of stay were observed in the conservative kidney management group based on frailty status. In the conservative kidney management group, frailty was not associated with mortality (HR 1.42, 95% CI 0.71–2.84; p = 0.3), however, being malnourished was associated with reduced 2-year survival (HR 2.10, 95% CI 1.13–3.90; p = 0.024).

Frailty and malnutrition are common, resulting in adverse outcomes in elderly conservative kidney management and dialysis populations. Nutrition is a key intervention in both frailty and malnutrition, with clinical trials needed to evaluate safe and effective interventions.

The online version contains supplementary material available at 10.1007/s40620-025-02356-9.

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