The 11-item modified frailty index (mFI-11) as a tool to predict mortality in older patients on chronic hemodialysis

Abstract

Objective To analyze the 11-item modified frailty index (mFI-11) as a predictor of mortality among older adults on chronic hemodialysis. Method A prospective observational study conducted in dialysis units in the municipality of Niterói (RJ, Brazil). A total of 124 patients on hemodialysis (HD) for at least 3 months, who began renal replacement therapy at the age of 65 or older, were followed for 24 months. Frailty was measured using the mFI-11, which comprises 9 comorbidities, 1 functional item, and 1 cognitive item. The comorbidities were obtained through anamnesis and medical record review. Functional dependency was determined by the presence of 2 or more dependencies on the Katz scale, and cognitive deficit was measured by the Mini-Mental State Examination (MMSE). The cutoff point for frailty was defined as mFI-11 ≥3. Results The mean age at the start of the study was 76 years, and 55.6% were men. Of the 124 participants, 56.5% had diabetes, 21% had functional dependency, and 52.9% had cognitive deficits. The prevalence of frailty was 67.7%, and an mFI-11 score of ≥3 was significantly associated with an increased risk of death (HR 2.39, 95% CI 1.21-4.72). Conclusion The mFI-11 demonstrated good performance in predicting mortality in older adults on HD. Its simplicity and feasibility make it a valuable tool for clinical practice, aiding in advanced care planning.