Frailty in Patients on Hemodialysis Is Independently Associated with Hearing Loss, Age, and Diabetes: Results from a 229-Patient Cohort

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Background: Frailty is highly prevalent among elderly patients undergoing hemodialysis (HD), yet its association with hearing loss—a common geriatric syndrome—remains largely unexplored in this population. Methods: We conducted a cross-sectional study involving 229 HD patients at a single center from November to December 2024. Inclusion required independence in daily activities; patients with severe dementia or profound hearing loss were excluded. Frailty status was assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria and categorized as robust, pre-frail, or frail. Hearing levels were evaluated using an audiometer prior to dialysis sessions, with both low-frequency (1000 Hz) and high-frequency (4000 Hz) thresholds classified into normal, mild, moderate, or severe hearing loss. Correlation and multivariate regression analyses were performed to evaluate associations between frailty and clinical covariates including age, sex, diabetes, dialysis vintage, and serum albumin. Results: Of the 229 patients (65.5% male; mean age 69.0 ± 11.7 years; mean dialysis vintage 8.1 ± 7.7 years), 24.8% were frail, 63.3% pre-frail, and only 11.7% robust. Low-frequency hearing loss, diabetes, and older age were significantly correlated with higher frailty scores. Multivariate analysis revealed that low-frequency hearing loss (p < 0.01), diabetes (p < 0.01), and age (p < 0.05) were independent predictors of frailty (adjusted R2 = 0.22). Conclusion: This is the first study to demonstrate a significant association between low-frequency hearing loss and frailty in HD patients. Given the regular clinical encounters in this population, integrating audiometric screening and frailty assessments into routine HD care may help identify at-risk individuals and improve physical outcomes and quality of life. Funding: Private Foundation Support

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