Objective  To explore the FRAIL scale and fragile index （FI） and adverse outcomes of elderly maintenance hemodialysis （MHD） patients.

Methods  From June 2020 to December 2022, 116 elderly patients on MHD were selected and assigned into two groups of survival （n = 27） and mortality （n = 89） according to the endpoint events. Clinical profiles were recorded. FRAIL scale and FI were utilized for assessing the frailty status. The correlation between FRAIL scale and FI and adverse outcomes was examined by multivariate COX regression. The predictive value of FRAIL scale and FI for adverse outcomes was evaluated by receiver operating characteristic （ROC） curve.

Results  The proportion of frailty assessed by FRAIL scale and FI was higher in mortality group than that in survival group （P = 0.001）. Multivariate Cox regression analysis indicated that, after adjusting for age, gender, body mass index （BMI）, diabetes mellitus, high blood pressure, primary disease, Charlson comorbidity index （CCI）, continuous renal replacement therapy （CRRT） and vascular access, hazard ratio （HR） and 95% confidence interval （95%CI） of FRAIL and FI were 18.552（2.249-153.018） and 7.367（1.864-29.115）, respectively. ROC analysis showed that the area under the curve of FRAIL scale and FI for predicting adverse outcomes was 0.792 and 0.711, respectively, and the area under the curve of FRAIL scale was significantly higher than that of FI （Z = 2.135, P = 0.033）.

Conclusion  With a strong correlation with adverse outcomes in elderly MHD patients, both FRAIL scale and FI may well predict adverse outcomes and FRAIL offers a better predictive capability.