Aims: End-stage renal disease patients undergoing haemodialysis often require inpatient rehabilitation following acute hospitalisation. The impact of frailty on rehabilitation outcomes in this population remains underexplored. This study explores the prevalence of frailty in rehabilitation patients on haemodialysis and its effect on rehabilitation outcomes.
Methods: This retrospective observational study included rehabilitation inpatients on haemodialysis at a Queensland tertiary hospital (2021–2024). Frailty was assessed using the Clinical Frailty Scale (CFS), categorising patients as non-frail to mildly frail (CFS ≤ 5) or moderate-to-severely frail (CFS ≥ 6). Functional Independence Measure (FIM) scores and rehabilitation outcomes were compared between groups. Logistic regression evaluated frailty as a predictor of FIM efficiency.
Results: Among 78 admissions (68 patients, mean age 67 years, 62% male), 10% were non-frail, 65% mildly frail, and 24% moderate-to-severely frail. Moderate-to-severely frail patients had a higher Charlson Comorbidity Index (p = 0.04) and poorer rehabilitation outcomes, including smaller functional improvements (mean FIM change: 12 vs. 24, p = 0.04). They were less likely to achieve meaningful FIM improvements (29% vs. 58%, p = 0.04), and more likely to require higher levels of care upon discharge (37% vs. 5%, p = 0.001). Each one-point increase in CFS was associated with a 0.4 reduction in FIM efficiency (95% CI 0.1–0.8; p = 0.02).
Conclusions: Frailty is prevalent in rehabilitation patients on haemodialysis and predicts poorer functional recovery and higher care needs. Nevertheless, frail patients can still achieve functional improvements, highlighting the importance of frailty assessment to guide rehabilitation and optimise outcomes.