Association between frailty, frailty domains, and health-related hope in patients with pre-dialysis chronic kidney disease

• Frailty is negatively associated with health-related hope in patients with pre-dialysis CKD. • Specific frailty domains, such as depressive symptoms, reduce health-related hope. • Worsening frailty leads to lower levels of health-related hope. • Comprehensive care strategies targeting frailty may enhance health-related hope. Health-related hope is crucial in managing chronic kidney disease (CKD), but factors influencing it remain unclear. This study examined the relationship between frailty and health-related hope and identified specific frailty domains affecting health-related hope in patients with pre-dialysis CKD. This cross-sectional study included patients with pre-dialysis CKD aged ≥ 50 years, without dialysis or kidney transplantation history. Frailty and specific frailty domains were measured using the Kihon Checklist, while health-related hope was assessed with a validated scale. Health-related hope scores were compared across robust, pre-frailty, and frailty groups using one-way ANOVA. Multivariate regression analysis was used to examine associations while adjusting for confounders. Among 285 patients in the analysis, the mean age was 67.9 years, 249 (87.4%) were male, and the mean estimated glomerular filtration rate was 40.7 mL/min/1.73m 2 . Mean health-related hope scores were 63.1 in the robust group, 54.5 in the pre-frailty group, and 41.4 in the frailty group, indicating lower levels of health-related hope among patients with greater frailty. In the adjusted model of multivariate regression, pre-frailty (β: -0.21, B: -9.3, 95% confidence interval [CI]: -14.5 to -4.1) and frailty (β: -0.43, B: -19.8, 95%CI: -25.2 to -14.4) were significantly associated with lower health-related hope. Additionally, depressive symptoms, reduced oral, cognitive, and physical function, and being homebound were also linked to lower health-related hope. Frailty and specific frailty domains were associated with lower health-related hope in patients with pre-dialysis CKD. These findings underscore the importance of comprehensive frailty assessment and interventions addressing physical, psychological, and social factors.