Frailty and symptom burden as predictors of kidney disease-specific quality of life among Filipino patients undergoing maintenance hemodialysis

Aim: This study determined the levels of frailty, symptom burden, and kidney disease-specific quality of life among Filipino patients undergoing maintenance hemodialysis, examined differences across dialysis vintage groups, and assessed the relationships and predictive associations of frailty and symptom burden with quality of life.Methodology: A cross-sectional predictive-correlational study was conducted among 165 consenting adults undergoing hemodialysis for at least three months at five private dialysis centers in Pampanga, Philippines.Data were collected using the FRAIL Scale, the revised Edmonton Symptom Assessment System (ESAS-r), and three kidney disease-targeted domains of the Kidney Disease Quality of Life-36 (KDQOL-36).Statistical analyses included the Kruskal-Wallis H test, one-way analysis of variance, Spearman's rank-order correlation, and multiple linear regression, with a significance level of .05 and Bonferroni correction applied within each research question.Results: The mean frailty score was 1.76 (SD = 1.51), with 127 participants (77.0%) classified as pre-frail or frail.The mean symptom burden score was 27.98 (SD = 13.24).Mean quality-of-life scores ranged from 70.83 for Symptoms and Problems of Kidney Disease to 42.01 for Burden of Kidney Disease.Frailty differed significantly across dialysis vintage groups, H(2) = 12.42, p = .002,ε² = .076.However, differences in the Burden of Kidney Disease (p = .029)and Effects of Kidney Disease (p = .042)domains did not remain significant after Bonferroni correction.Frailty (ρ = -.315 to -.383) and symptom burden (ρ = -.428 to -.631) were negatively associated with all three quality-of-life domains (p < .001).Together, the two predictors accounted for 21.8% to 45.0% of the variance in domain scores, with symptom burden demonstrating the stronger predictive association in every model.The strongest observed associations involving symptom burden may partly reflect overlapping item content between the measures.Conclusion: Symptom burden demonstrated a stronger association with kidney disease-specific quality of life than frailty among the participating patients.These findings highlight the importance of systematic symptom assessment in nursing care, alongside frailty screening to identify patients who may benefit from closer assessment and individualized support.Because the study used a cross-sectional design, the findings indicate associations rather than causal relationships and should be interpreted within the context of the five participating private dialysis centers.